Summary:

This erudite collection of twelve essays by a physician-scientist weaves allegory, myth, clinical experience, science, and western history and religion (particularly Catholicism) with ruminations on the meaning of medicine and health. The author is the chair of the Department of Medicine at Jagiellonian University School of Medicine in Cracow, Poland – a university founded in 1364 and which counts Copernicus and Pope John Paul II as alumni. Hence it is with this sense of history that the author addresses such topics as cardiology, pain and its relief, genomics, critical care, infectious disease, health care financing. For instance, in Chapter VII “A Purifying Power” Szczeklik traces the word “katharsis” (the title of the book in the original Polish) to the Greek chorus, Pythagoras and Aristotle, then explores the interplay between music and medicine.

Some of the memorable clinical tales are of the reanimation of a frozen man and the resuscitation of a man who drags himself to the newly opened critical care unit and then very cooperatively codes. The narratives about research, such as the self-experimentation with prostacyclin just after its discovery in the 1970s, are also riveting.

The scope includes the realms of science and religion. For instance, Szczeklik mentions both the Papal Academy of Sciences session on evolution (Pope John Paul II: “The scientific theory of evolution is not at odds with any truth of the Christian faith.” p. 128) as well as religious overtones to metaphoric declarations about the power of the genome (“the language of God” p. 125).

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This film tells the remarkable story of Vivien Thomas (played by Mos Def), an African-American fine carpenter, who found his way into medicine through the back door and changed medical history. Hired when jobs were in short supply to work as a custodian and sometime lab assistant to Dr. Alfred Blalock (Alan Rickman), a research cardiologist, Thomas quickly becomes an irreplaceable research assistant. His keen observations, his skill with the most delicate machinery and, eventually, in performing experimental surgery on animals, make clear that he has both a genius and a calling.

Though the relationship has its tensions (Blalock, as a Southern white man and a doctor, has some blind spots in the matter of mutual human respect, though he highly values Thomas’s skills) it lasts for decades. The two move their families to Baltimore, where Blalock becomes Head of Surgery at Johns Hopkins and, much to his colleagues surprise and to some of their dismay, brings Thomas in to perform groundbreaking open heart surgery on a blue baby. It is not until after Blalock’s death that Thomas is granted an honorary doctorate from Johns Hopkins, where he continues to work in research until his own retirement.

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The novel is set in Washington, DC in April, 1865. At fourteen, Emily is sole caretaker of her mother who is dying of tuberculosis. Her neighbor, Annie Surratt, is her best friend, though their mothers have been estranged for some time. Both families have deep roots in the South. Annie’s brother, Johnny, an object of Emily’s romantic fantasies, has recently left on a secret mission. The war is nearly over. Emily’s uncle Valentine, a physician, wants to take custody of her after her mother dies, but because her mother has also felt estranged from him, Emily resists. Still, after her mother’s death, she does go to live with her uncle, and learns that he (with his two assistants, one of whom is a woman who is 1/8 African American) has a lively practice among the poor and the African Americans who have flooded the streets of Washington since the emancipation.

Valentine is called to Lincoln’s bedside the night of his assassination, and participates in efforts to track down John Wilkes Booth and his accomplices, one of whom appears to have been Johnny Surratt, who has escaped to Canada. In the course of her time there Emily discovers that her uncle and his assistant are involved in elaborate, marginally legal, schemes to obtain bodies for study at the medical college. Emily, at first horrified by this discovery, comes to recognize the good that comes of anatomical studies and to sympathize with her uncle’s efforts to bring about legislation making the acquisition of bodies for medical research easier. Annie’s mother is hanged as an accomplice in the Booth conspiracy, Annie leaves town, and Emily comes to understand a great deal more about the harsh terms on which life must be lived in times of national crisis and ideological warfare. The story ends with her growing interest in medicine as a possible career path.

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In 1996, at the age of 31, David Biro is preparing for his specialty examinations in dermatology and is set to share a practice with his father. But he develops a visual disturbance. After repeated testing, he is found to have the rare blood disorder of paroxysmal nocturnal hemoglobinuria. The diagnosis was problematic, but the treatment choices are overwhelming. His youngest sister is a suitable donor, and he opts for a bone marrow transplant. He realizes that his decision was influenced not only by the diagnosis, but also by his personality and his reaction to the physicians.

Advance preparations are hectic and sometimes comic, especially his deposits at a local sperm bank. The pain of the transplant and the six weeks imprisonment in a small hospital room are told in graphic detail. The athletically inclined doctor suffers many complications: exquisitely painful ulcers of the scrotum, mouth, and esophagus; inflammation of the liver; unexplained fever; drug-induced delirium; weakness and weight loss.

His parents, sisters and friends leap into action to provide round-the-clock presence, but his independent wife, Daniella, resents the invasion. While David’s body is wracked with drugs and radiation, his family and his marriage are subjected to destructive forces too. Yet all--body, family, and marriage--emerge intact, though changed, by their experience.

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After working with the Parisian physiologist, François Magendie, Dr. John Leggate returns to England to practice in the town of Middlethorpe in the late 1840s. He is obsessed with making a research discovery that will help humanity and establish his name. He falls in love with the intelligent and gifted Marian Brooks who aspires to a career as a concert pianist after study in Leipzig with Felix Mendelsohn. They marry and find happiness at first, but she is troubled by discovery of his past affair in France, and he is troubled by her abandoning music simply to be the type of wife he never wanted.

Leggate has a theory about the origins of cholera, but his painstaking work shows him two things: 1. his original idea is mistaken, and 2. the disease is spread by water. He does not publish, though he announces his intentions to do so. Intimidated by skeptical colleagues, he is unable to write, and the problem is exacerbated by a newspapermen who makes unwarranted accusations because he holds a grudge against Leggate’s wife.

Marian wants to help him, but he rejects her offers and retreats into himself. Their marriage is threatened. Just as cholera returns and the town learns from Leggate’s insights, John Snow publishes his famous observations on cholera. Leggate is scooped. He and Marian migrate to Canada where he is accepted for his skills and desire to be of service and she establishes a conservatory of music. Their marriage is restored.

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An extraordinary phenomenon began to emerge a century or so ago, which, as it proceeded, allowed us a glimpse into what a society would look like when most of its members, rather than a select few, lived to, or more precisely, near, the limit of the human lifespan. Now we are facing the possibility of extending the upper limit of the human lifespan. How we live within this new world will be the result of numerous individual as well as corporate (in its fullest sense--business, professional societies, religious organizations, political bodies) decisions.

Stephen Hall, through compelling and clear writing takes us behind the scenes and into the lives and labs of the researchers and entrepreneurs who are seeking to slow down, stop, or reverse the aging process--those who intend to bring about, if not actual, then practical immortality. Figuring prominently throughout the book are Leonard Hayflick, early pioneering researcher on aging cells, and the charismatic (and former creationist) researcher-entrepreneur, Michael West. Rounding out the narrative are commentaries by noted ethicists and the chronicling of the political responses to these scientific and business developments, especially in regard to stem cell research.

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In their introduction to this anthology, the editors write that their goal is "to illustrate and to illuminate the many ways in which medicine and culture combine to shape our values and traditions." Using selections from important literary, philosophical, religious, and medical texts, as well as illustrations, they explore, from a historical perspective, the interactions between medicine and culture. The book is arranged in nine major topical areas: the human form divine, the body secularized, anatomy and destiny, psyche and soma, characteristics of healers, the contaminated and the pure, medical research, the social role of hospitals, and the cultural construction of pain, suffering, and death.

Within each section, a cluster of well-chosen (and often provocative) texts and drawings illuminate the topic. Specifically, literary selections include poems by W. D. Snodgrass ("An Envoi, Post-TURP"), William Wordsworth ("Goody Blake and Harry Gill: A True Story"), and Philip Larkin ("Aubade"); and prose or prose excerpts by Robert Burton ("The Anatomy of Melancholy"), Zora Neale Hurston (My Most Humiliating Jim Crow Experience), Sara Lawrence Lightfoot ("Balm in Gilead: Journey of a Healer"), William Styron (Darkness Visible: A Memoir of Madness), George Orwell ("How the Poor Die"), Ernest Hemingway (Indian Camp), and Paul Monette (Borrowed Time: An AIDS Memoir). (The full texts of the pieces by Hurston, Styron, Hemingway, and Monette have been annotated in this database.)

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This anthology frames a rich selection of fiction and nonfiction with astute and helpful introductions to issues in nineteenth-century medicine and the larger culture in which it participated. The fiction is comprised of Mikhail Bulgakov’s The Steel Windpipe in its entirety; Sir Arthur Conan Doyle’s story, "The Doctors of Hoyland" from Round the Red Lamp; and selections from George Eliot’s Middlemarch, Gustave Flaubert’s Madame Bovary, Sarah Orne Jewett’s A Country Doctor, Sinclair Lewis’s Arrowsmith, Thomas Mann’s Buddenbrooks, W. Somserset Maugham’s Of Human Bondage, George Moore’s Esther Waters, Robert Louis Stevenson’s Strange Case of Dr. Jekyll and Mr. Hyde, Eugène Sue’s Les Mystères de Paris, and Anthony Trollope’s Doctor Thorne [the full-length versions of many of the above have been annotated in this database]. The nonfiction consists of two versions of the Hippocratic Oath, two American Medical Association statements of ethics, and selections from Daniel W. Cathell’s The Physician Himself (1905).

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Ashdown, a beautiful but bleak manor on the English coast, is the main setting of this story. Initially, a group of university students including Sarah Tudor, Gregory Dudden, Robert, and Terry reside at Ashdown. Some of these same students return there years later as either patients or staff when the building is converted into the Dudden Clinic where individuals with all sorts of sleep disorders are treated.

Sarah is a disturbed young woman suffering from narcolepsy. She is sometimes unable to differentiate her dreams from the experiences of real life. Robert is infatuated with her and will do literally anything to please her. Gregory is Sarah’s first lover, later a psychiatrist in charge of the sleep clinic, and finally a man gone mad who decides to self-experiment. Dr. Cleo Madison is a sleep psychologist whose true identity is a surprise. In this novel, reality appears more surrealistic than most dreams.

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A mystery, set in the seventeenth century and told by four different eye-witnesses, all men. Two are the views of fictitious characters, two are imputed to be real figures from the past. Beautiful, but poverty-stricken Sarah Blundy is accused of having killed a professor, only remotely connected to her. Each of the observers reasons his way to a position on her guilt or innocence based on their skewed observation of the events, and on their own assumptions about women, religion, and justice. Post-Cromwellian tensions between Catholics, Protestants, and Quakers are explored.

A manuscript by the Italian, Dr. Cola, constitutes the first account. In the thrall of medical science and the great Robert Boyle, Cola is cast as the true "inventor" of transfusion which is "stolen" by the real and vibrant Richard Lower, generally credited by historians with its first use in England. Cola attends Sarah’s ailing mother gratis and transfuses her with modest success.

The other three writers react to his version of the tale which they read in manuscript. The mad Jack Prescott is intent on exonerating his probably inexonerable father for misdeeds in the Civil War, while the uncharitable cryptographer, John Wallis, is intent on divining nothing but evil in the cryptic forms of women, Catholics, and foreigners. Their versions are wondrously convoluted attempts to keep the impossible within the realm of the plausible. Pears puts the truth (such as it is) in the words of the real antiquarian, Anthony Wood, who explains that a fingerpost--like a pathognomonic sign--points to the only solution possible.

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