Featured Books: Archives
Location: History of Medicine & Health Care Collection
Call Number: WZ 100 C518f 2007
"If you would endure life, be prepared for death."—Sigmund Freud
After quoting Freud in her New York Times bestseller, Final Exam: A Surgeon's Reflection on Mortality, Dr. Pauline Chen comments, "Preparing for death may be the most difficult exam of all, but it is the one that will finally prepare us to live" (vii). Educated at Harvard and Yale, a prize-winning transplant and liver cancer surgeon, and a regular New York Times columnist, the author began medical school with dreams of saving lives -unaware of the powerful role death plays in her profession. Chen admits, "Like most of my colleagues, I came into medicine poorly equipped to deal with terminal patients. I had little experience with the dying beforehand and like many physicians harbored a profound aversion to death" (xiii). She notes that physicians are trained to think of death as an adversary to whom they must never surrender.
A physician's total dedication to keeping his or her patient alive may seem a most admirable trait. But Chen reveals that this mind set too often becomes an intractable refusal to accept the inevitability of death, resulting in unnecessary suffering for patients and their families. Holding out hope becomes a cruel hoax when dying patients, truly no longer able to benefit from further medical treatment, would most benefit from a compassionate preparation for death.
Unfortunately, American physicians, so well trained to fight disease, are relatively unschooled in how to provide comfort and support to their dying patients. As Chen says, "For doctors, this care at the end of life is, as this book's title implies, our final exam. Unfortunately, few doctors are up to the task" (xiii). She convincingly argues that doctors must be better prepared for this most final of tests. Hardly the first to criticize the medical profession for deficiencies in end-of-life care, Chen compels our attention through her vividly described anecdotes and the shocking clarity of her language, as in this sensuous medical school memory: "Formaldehyde, the preservative used for cadavers, has an unmistakable odor- sharp, rancid, piercing- like the olfactory version of a high-pitched shriek." (9).
Chen impresses, too, with her utter honesty. We come to trust her as a surgeon who performs a vivisection of her own soul. She confesses her early insecurities: "As a medical student on the wards, I felt awkward enough because of my negligible clinical experience, but it was that shared vulnerability with patients that made me feel completely vulnerable" (45). She later confesses that, as a fully fledged physician, she continues to feels guilty for avoiding a dying patient, and of a time when she felt responsible for the death of a patient.
Chen divides her book into three parts: "Principles; Practices; and Reappraisal." In "Principles," Chen describes her first encounters with death in medical school-the cadaver dissection, the first resuscitation, and the first pronouncement of death. She reflects on how these experiences, some she describes as "terrifying," profoundly affect medical school students (xiv). They often undergo these first encounters without psychological or emotional support; yet such experiences have a lasting effect, influencing their attitudes toward death when they become practicing doctors. Remembering her early stages of training as a medical student, Chen recalls the natural qualms any of us would feel in the anatomy lab before making that first incision into human flesh. In striking detail, she describes how she came to admire the exquisite intricacy of the body while ruing the demise of the woman who lay before her.
Chen explains how her ambitions to be a healer blinded her to the inexorable reality of death. Again, she quotes Freud, who noted our universal illusions about death: "In the unconscious, everyone is convinced of his own immortality" (10). Citing Sherwin Nuland's How We Die, she notes that medicine attracts those with special anxieties about death. "We become doctors because our ability to cure gives us power over that of which we are afraid" (60). Chen's revelations about her profession's denial of death emerge as especially credible given her frank and brave confessions of the discovery within herself of the dehumanizing effects of becoming a doctor.
However, she concludes that doctors in training eventually find ways to distance themselves from the fact that their cadavers were once living, breathing men and women. "Taking the cues from their teachers, medical students learn to deny their own feeling, depersonalizing the dissection experience and objectifying their cadaver. They strip away the cadaver's humanity, and soon enough they are dissecting not another human being but 'the leg' or 'the arm'" (17). She regrets that "I learned from many of my teachers and colleagues to suspend or suppress any shared human feelings for my dying patient, as if doing so would make me a better doctor" (viii).
In the second part of the book, "Practices," Chen reveals what happens when medical students become doctors. She smoothly weaves together anecdotes from her personal experience with research findings. For example, she cites a mid-1990s study of end-of-life care revealing that a majority of physicians knew nothing about their patient's attitudes toward resuscitation and seemed unaware of their terminal patients' degree of pain. Another study showed that one-quarter of oncologists do not tell patients they are dying of an incurable disease, and that doctors rate themselves as "poor" or "fair" in delivering bad news to their patients. Worse, attempts at reforming the system by implementing more intensive interventions, hiring more capable staff, and establishing better accountability resulted, two years later, in no notable improvements.
Accounting for these dismal results, Chen notes that doctors, unable to deny their patients' optimism, continue treatment despite the hopeless situation. Another factor, increased specialization, means that no one physician is ultimately responsible for carrying out end-of-life choices, so all involved can avoid the dreaded admission of the inevitable. She explains that financial or legal reasons, including a doctor's greed or fear of litigation, can result in unnecessarily prolonging a patient's life. Furthermore, the onerous constraints of managed care, the endless paper work, and the relentless limitations of time --all increasingly divide physicians from their terminally ill patients.
In the last section of her book, "Reappraisal," Chen insists that despite the formidable impediments, change can occur once physician acknowledge their own mortality and a shared humanity with our patients. She argues that more doctors can be sensitized to the needs of their dying patients, noting efforts by the American Board of Internal Medicine to require residents to care for dying patients as part of their training. Chen also provides examples of good palliative care, telling the moving tale of a physician who took the time to comfort the family during the last moments of a patient's life, illustrating how doctors sometimes can sooth pain more effectively than medication. She describes the courage of patients and their families in confronting death, and how she learned from them to better care for terminal patients.
Finally, in the "Epilogue," Chen describes her painful experience with a dying patient, Doreen, a former teacher whom she admired. Devastated by Doreen's death, Chen concludes, "Our grief is the price we pay for caring for the terminally ill, and our aversion is the weight that anchors our inertia and denial" (217). With this kind of insight, Pauline Chen convinces us that she is indeed one physician with both the knowledge and wisdom to pass with distinction her "Final Exam."
David T. Courtwright. Forces of Habit: Drugs and the Making of the Modern World, Harvard University Press, 2001. Reviewed by Harvey Fenigsohn.
Location: History of Medicine & Health Care Collection
Call Number: WM 11.1 C866f 2001
"The obese Marquis de Sade was obsessed with [chocolate] in all forms. From prison, he badgered his wife for ground chocolate, crème au chocolat, chocolate pastilles, and even cacao butter suppositories to soothe his piles. 'I asked ... for cake with icing,' he wrote in 1779, 'but I want it to be chocolate and black inside from chocolate as the devil's ass is black from smoke'" (p. 23).
Chocolate is just one of the psychoactive substances David T. Courtwright discusses in Forces of Habit, Drugs and the Making of the Modern World, the source of the above colorful quotation. Is chocolate a drug? For Courtwright, most certainly, yes, as the author considers a drug to be "any psychoactive substance, licit or illicit, mild or potent, deployed for medical and non-medical purposes" (p. 2). He includes alcoholic and caffeinated beverages, chocolate, coca, cannabis, and tobacco as well as so called hard drugs such as morphine, heroin, cocaine, methamphetamine, and other mind-altering substances, synthetic or semi-synthetic. Courtwright acknowledges that the sheer number of different drugs makes it impossible for him to discuss them all.
The author terms the most widespread drugs, alcohol, tobacco, and caffeine, "The Big Three," (p.9), and he labels the next three most important but less often consumed drugs, opium, cannabis, and coca, "The Little Three" (p. 31). He also considers many other psychoactive substances including those confined to small areas such as kava in East Africa and the betel nut in Papua New Guinea. He notes that scholarship on drug history tends to focus on particular drugs in particular settings, such as mescal in Mexico or ganja in Jamaica.
Courtwright's range envelops the globe as he traces the ancient and modern origins of numerous habituating substances, considers their use and abuse over the centuries, and analyzes their significance as determined by trade, politics, and culture. Viewing the subject with an expansive lens, he also zooms in, concentrating on illustrative case histories such as the story of James Duke and the cigarette industry, the struggle to control alcohol abuse in India, and the debilitating effects of opium in China.
The historian's method entails carefully tracking a drug's movements across the globe and through time, analyzing the commercial, cultural, and psychological reasons for that drug's popularity. For instance, accounting for the prevalence of coffee, he follows the trail of the world's most popular, profitable caffeinated beverage, indigenous to Ethiopia, first extending to Arabia, then to other Islamic regions, and finally to Asia, Europe, the New World, and beyond: "Apollo 11 astronauts were drinking coffee three hours after landing on the moon" (p. 21).
The author reveals how market driven forces, hedonic reactions, and moral reasoning have affected a drug's use. He discloses why certain once illegal drugs are legal today, and why other formerly legal drugs are now strictly controlled, if not banned altogether—though often unsuccessfully, given their marketability and allure. Courtwright shows how national governments, unable or unwilling to suppress addictive drugs, tax toxic substances to enhance revenues despite the pernicious effects on its citizenry. As he observes, "The clash between opportunities for profit and concerns about health forms the central moral and political conflict running through the history of psychoactive commerce" (p. 91).
Courtwright contends that throughout history, political and capitalist elites found drugs highly useful in maintaining social control. Chinese coolies remained docile and less likely to rebel if numbed by opium, while the English working class stayed compliant if consoled by gin. The Romans soothed their soldiers with wine, and U.S. soldiers in World War II calmed their nerves with government issue cigarettes included in their K-rations. Courtwright notes, too, the fashionable attraction of a drug for certain social groups such as the snob appeal of chocolate for the Mayan and French aristocracies, and the mystique of LSD in the counter culture of the sixties.
Accounting for the global popularity of tobacco, Courtwright dazzles us with the enormity of the nicotine plant's popularity, despite its many proven health risks. He observes, "By the mid-90s, the world had an estimated 1.1 billion smokers- a third of the population over age 15- smoked 5.5 trillion cigarettes annually. That sum represented a pack a week for every man, woman, and child, smoker or non-smoker, on the planet" (p. 19). Tobacco smoking in this country has since been dramatically reduced, but prevails in other parts of the world as a cash crop and as a stimulant, despite earlier brutal attempts to suppress its use. "Russian smokers (once) suffered beatings and exile; snuff takers had their noses torn off. Chinese smokers had heads impaled on stakes …" (p. 16).
The author shows that relentless advertising and hype can make an American drug internationally fashionable, explaining the ways "Coca-Cola … a blend of the two most massive stimulants [caffeine and kola] known to pre-industrial cultures" (p. 26), gained global popularity. The soft drink became a national icon, once described by the company's CEO as the "sublimated essence of all America stands for, a decent thing honestly made, universally distributed, conscientiously improved through the years" (p. 26).
Courtwright acknowledges the beneficial results of powerful psychoactive drugs in enhancing life and relieving human misery, if they are used responsibly. He recognizes, for instance, that moderate drinking, such as a glass of wine a day, may provide protection against stroke, adult-onset diabetes, and osteoporosis, and he endorses the psychological benefits of coffee. In tracing the arc of drugs through history, Courtwright also shows how drugs now considered addictive, such as tobacco, alcohol, and cocaine, were once viewed as medically beneficial. He explains, as well, how certain drugs once used medicinally have come to be severely abused, e.g. morphine, amphetamines, and barbiturates.
Having earlier listed the progression of official approaches to drugs from "pure prohibition" to "universal access" (p. 188), Courtwright ends by endorsing stronger governmental regulations, i.e., "restricting commerce and profit" through "regulatory laws and treaties" (p. 206). Unfortunately, he does not explain how we might better implement these measures beyond our present efforts, nor does he fully explore the nexus of international crime driving the drug trade, such as the influx of hard drugs into this country. Courtwright, as well, neglects any serious consideration of the libertarian view that the solution to the drug problem is to make more drugs legal. Strangely, too, though he provides a most interesting and complete history of marijuana use in this country, he does not address the issues raised by the movement to decriminalize cannabis for medical purposes.
Nevertheless, the countless achievements of the book far outweigh its few shortcomings. In a smooth, pithy style, sometimes humorous, always illuminating, the author cites an impressive variety of primary sources—official, private, scientific, literary. He commands an army of well-chosen facts to establish his expertise and supplies striking quotations to enliven his text for both general readers and academic specialists. In Forces of Habit: Drugs and the Making of the Modern World, David T. Courtwright presents a comprehensive study, thoroughly scholarly and refreshingly readable.
Judith Walzer Leavitt. Typhoid Mary: Captive to the Public's Health, Beacon Press, 1996. Reviewed by Harvey Fenigsohn.
Location: History of Medicine & Health Care Collection
Call Number: WC 270 L439t 1996
"I am an innocent human being. I have committed no crime and am treated like an outcast - a criminal. It is unjust, outrageous, uncivilized. It seems incredible that in a Christian community a defenseless woman can be treated in this manner. … Why should I be banished like a leper…?" (p. 180).
Thus, Mary Mallon, better known as "Typhoid Mary," bitterly protested her exile to an island in New York's East River. For over 26 years Mallon was confined against her will until her death at age 69 in 1938. In Judith Walzer Leavitt's Typhoid Mary: Captive to the Public's Health, we learn the extraordinary story of this infamous carrier of typhoid fever, and consider how Mary Mallon's treatment can help determine today's public health policies. Leavitt's analysis, compellingly documented and lucidly crafted, challenges us to balance the public's need for safety and health with the individual's right to freedom and justice.
An indigent, fifteen year old Irish immigrant to this county in 1883, Mary Mallon became a valued domestic servant, sought by well-to-do New Yorkers for her culinary skills. Unfortunately, the scourge of typhoid fever continuously plagued the homes where Mallon worked. Linking Mallon with the disease, the relentless medical detective, George Soper, tracked her down, insisting that she be tested. Soper rightly suspected that Mallon was a healthy carrier of typhoid fever. As the heralded new science of bacteriology proved, though healthy themselves, such carriers could unwittingly spread the disease to those with whom they came in close contact. Health officials soon determined that from 1900 to 1907, Mary Mallon infected at least twenty two people. Eventually, Mallon infected 47, causing three deaths.
Confronted with the news that she was suspected of spreading typhoid fever, Mallon fiercely resisted any attempt to be tested, violently rebuffing health officers, asserting that she was completely healthy and a threat to no one. Mallon held this false belief until the day she died. Leavitt reveals that Mallon, while responsible in part for her long incarceration, was not merely the victim of typhoid fever. Rather, as a lower class woman, and Irish Catholic, Mallon suffered from the powerful prejudice at that time directed against those of her gender, her social status, and her ethnic background.
Mallon, who lived alone with no family and associated with a disreputable male friend, was considered unwomanly. In contrast to those she infected, who were upper class and privileged, she was viewed as a menace to respectable society. What is worse, she defiantly refused to accept that she was a danger to others; when granted her freedom after agreeing to refrain from working as a cook, Mallon secretly reverted to making her living the best way she could- cooking for others. After infecting 23 more people, Mallon was apprehended once again and condemned in 1915 to spend the remainder of her days on North Brother Island.
In analyzing Mary Mallon's role in early 20th century America, Leavitt explains why and how she, alone, was demonized, her epithet, "Typhoid Mary" continuing today to represent someone to be feared and reviled, a toxic danger to all. The author reviews the sensational trial of 1907 when the protection of the public's health was pitted against Mallon's right to live as a free woman. While Mallon was first portrayed sympathetically in the newspapers, her documented threat to the community and her refusal to accept this fact soon turned public opinion against her. Losing her court case, excoriated in the press, she spent two more years in isolation before a sympathetic public health official freed her. But, proving herself unwilling to observe her vow to never again work as a cook, Mallon realized her cause was hopeless.
Nevertheless, as Leavitt reveals, Mary Mallon was one of several healthy carriers to defy public health officials and continue working at their chosen profession. At least three other contagious carriers, some who infected more people than Mallon, were never forcibly confined, though they repeatedly resisted the prohibition against continuing to work as food handlers, the profession most likely to spread the disease. Unlike Mallon, they were men with families who, seemingly, were more willing to acknowledge their danger to others even as they found ways to defy those who would control them. As Leavitt indicates, this uneven application of justice revealed the ambivalence of public health authorities toward curtailing a citizen's freedom --even one clearly known as a deadly threat to the community.
In her final chapter, "A 'Square Deal' for Public Health," Leavitt considers the implications of Mallon's story for today's health policy in managing infectious diseases. She compares Mallon's disbelief when told she was a healthy carrier to the incredulous reaction of the first gay men informed, in the 1980's, that they had contracted AIDS and that their sexual behaviors might endanger others. Leavitt argues that the power of the government to identify contagious carriers can lead to simplistic labeling. She warns against stigmatizing those who contract infectious diseases, insisting the best results will occur only "if people who are infected are treated with respect and empathy for their personal stories" (238).
Finally, Leavitt examines the question of quarantine, the whole issue of isolation. She considers who should be quarantined and why, fully exploring the medical, legal, and moral concerns. Better heath precautions and the development of medications have made quarantining of AIDS patients less of a concern since the 1996 publication of Leavitt's book. But there will always be the need to treat bearers of contagious diseases with justice, even as the government rightfully protects its citizens from the threat of contagion. Reconsidering Mary Mallon's case, Leavitt suggests that this unfortunate woman might well have been trained in another means of gainful employment, a vocation comparable to cooking and equally satisfying. Treated with the dignity she deserved, rather than becoming an infamous example, Mary Mallon may have lived a different and better life. Instead we will always have the notorious case of "Typhoid Mary," a lesson in medical history we should never forget.
Frances K. Conley, M.D. Walking Out on the Boys, Farrar, Straus and Giroux, 1998. Reviewed by Harvey Fenigsohn.
Location: History of Medicine & Health Care Collection
Call Number: W 21 C752w 1999
"A strange freedom comes from knowing that I have little to lose by telling this story. I have acquired a curious inner peace … realizing, in my lifetime, I will not see women obtain the equality that should be theirs." Such is the pessimistic conclusion of Dr. Frances K. Conley in Walking Out on the Boys, her exposé of the pervasive misogyny she experienced at one of America's most prestigious medical schools. Nevertheless, despite nearly insurmountable barriers, Conley became the first woman to pursue a surgical internship at Stanford University Hospital (1966), and the first to become a tenured full professor of neurosurgery at an American medical school (1982). Her unprecedented accomplishments came at a painfully high price, one that nearly bankrupted her stock of self worth.
In Walking Out on the Boys, Conley describes the first thirty years of her career from her entrance into medical school in 1961 to her return to the Stanford faculty following a defiant resignation in 1991. Intelligent and independent, the child of a university professor, she found herself irresistibly attracted to medicine, gratefully becoming one of the twelve women out of sixty men in her medical school class. However, Conley soon realized that she had chosen a profession run entirely for and by men. An unwelcome threat to their dominance, her gender barely tolerated, she put up with the humiliating hostility directed against women who dared to join this exclusive fraternity.
Traditionally in the minority, women in all medical fields into the 1970s—but especially in hyper-masculinized fields such as neurosurgery, frequently acquiesced to domineering males, playing the servile roles expected of them. They were realistically convinced that any protest or resistance would seriously jeopardize their tenuous position. Thus, women accepted (if unhappily) routinely being passed over for promotion. They accepted being the subject of vulgar jokes and lewd rumors. And they accepted being patronized, insulted, and groped.
Conley endured the degradation, suffering silently. In choosing to specialize in neurosurgery, she confronted a gender bias that might well have deterred less ambitious peers, since the mere presence of an aspiring woman was considered an outrage. Nevertheless, Conley was accepted into a neurosurgical residency, ultimately becoming both a tenured professor and director of her own research laboratory.
Conley did not consider herself a feminist, nor was she. Instead, going along to get along, she attempted to ignore the malicious threats to her dignity that persisted even after she became a full professor. When female students and colleagues complained to her about their abusive treatment by male doctors, she told tell them that they had to toughen up and endure the inevitable harassment.
Conley unsuccessfully attempted to become, as she said, "one of the boys." After thirty years, she finally balked. Conley simply could not accept that Dr. Gerald Silverberg, acting chairman of neurosurgery, was to become permanent head of the department. Silverberg, an egregious male chauvinist, had earlier been accused of sexual harassment. Nevertheless, he continued his insensitive patronizing of the women in the hospital, addressing each as "honey" and making blatant physical advances toward every vulnerable woman. Frustrated in her attempts to prevent Silverberg's appointment, Conley finally resigned her position.
Neither Conley nor Stanford University was prepared for the embroilment which followed. When the local press banged the drum of publicity, Conley's actions quickly gained national attention. She went public with press conferences and a carefully worded opinion piece explaining the reasons for her resignation. In spite of herself, Conley soon become an outspoken and increasingly prominent symbol of sexism in medicine.
As the media storm intensified, the university hesitated to proceed with Silverberg's promotion. With the precision one would expect of a neurosurgeon, Conley describes the devious machinations of the administration which did all it could to protect the image of the medical school rather than respond to the injustices she had exposed. She came to realize that discrimination against women in medicine was both systemic and widespread when women from Stanford as well as from hospitals and medical schools around the country came forward to tell similar stories of discrimination and harassment.
Conley was viewed as a heroic crusader by some, but vilified by her enemies as was evident when her office was rifled, her name summarily removed from all Stanford stationery, and her research lab dismantled even before she had officially departed the university. When the federal government's Equal Employment Opportunity Commission (EEOC) became involved in the grievances at Stanford, the university finally decided not to appoint Dr. Gerald Silverberg as permanent head of the Department of Neurosurgery. After "walking out on the boys," Frances Conley decided to rescind her resignation, reclaiming her tenured faculty position.
Silverberg never attended the sensitivity classes required of him, but his kind of blatant sexism would never again be tolerated at Stanford. In addition to continuing her work at Stanford, Dr. Conley appeared at many other medical schools, encouraging women to resist the misogynistic culture they encountered in class rooms, laboratories, and hospitals.
Despite her vindication, near the end of her book, Conley expressed doubt that the inequities she suffered would be wholly eradicated in her generation. Nevertheless, even she might agree that today, despite some residual, subtle discrimination, women are gaining their rightful place in the world of medicine with help from women like Dr. Frances K. Conley.
Martin S. Pernick, The Black Stork: Eugenics and the Death of "Defective" Babies in American Medicine and Motion Pictures in America Since 1915, Oxford University Press, 1996. Reviewed by Harvey Fenigsohn.
Location: History of Medicine & Health Care Collection
Call Number: HQ 751 P445b 1996a
Though little known today, Dr. Harry J. Haiselden, a Chicago physician shocked the nation in 1915 by boldly revealing that he practiced what some would call infanticide. The doctor defiantly defended his right to withhold medical treatment of so called "defective" newborns. Inciting a firestorm, Haiselden began a widespread publicity campaign to convince the medical world and the general public of the morality of his actions—eliminating those infants he considered "unfit" to live.
Haiselden's most effective publicity was his sensational film, The Black Stork. Pure propaganda, the melodrama extolled the advantages of selective breeding and warned of the danger of couples with genetic disorders marrying and having children. His film dramatized the health benefits of not treating "defective" newborns, leaving them to die for their own good, the good of their parents, and the good of society. In his engaging book of the same title, medical historian Martin Pernick skillfully analyzes the powerful effects of The Black Stork. Using examples from other motion pictures and the popular press, he reveals how the mass media both reflected and shaped America's attitude toward eugenics and euthanasia.
The first half of Pernick's book provides a sweeping history of the medical and moral issues surrounding eugenics and euthanasia. Derived from the Latin, i.e., eu="good" and thanatos="death", euthanasia can be passive when treatment is withheld to relieve suffering, or active when actions are taken to bring about death in a so called "mercy killing." When Haiselden brought the subject to public attention through his film, the nation was sharply divided. Some well known figures such as Clarence Darrow and Helen Keller took the side of the doctor, while eminent social reformers including Jane Addams of Hull House opposed his advocacy of passive euthanasia. Pernick shows how these conflicted attitudes toward euthanasia continue today as Americans still grapple with questions of who should live and who should die.
Through the second half of his engaging and original study, in addition to The Black Stork, Pernick uncovers over a hundred now forgotten films, showing how they influenced and revealed popular thinking about complex moral issues. Lucidly composed and thoroughly researched, Pernick's book establishes the close connection between euthanasia and eugenics, the attempt to produce superior human beings by improving hereditary traits.
To that end, in the 1920s the U.S. government passed laws banning supposedly undesirable immigrant groups from entering the country. In addition, by 1939 an estimated 20,000 of the "unfit" had been sterilized, including African Americans, alcoholics, the immoral, criminals, prostitutes, and the mentally ill. Pernick traces how America's interest in eugenics can be linked to the Nazis' willingness to use murder to purify the race. He regrets that a movement in this country to overcome inherited diseases degenerated into what he considers "genocide," all because of hatred based on race, class, ethnicity, and gender.
Pernick exposes the limitation of the progressive era's belief that objective science could resolve troubling ethical dilemmas. Subtly influenced by culture and tradition, even seemingly objective science is value laden, yet the public has tended to leave grave decisions about life and death to those whose judgments are all too subjective. The author maintains that scientists, alone, are not equipped to decide about the treatment of those whose lives might never be normal, but who arguably deserve the right to life.
The controversial Baby Doe cases in the early 1980s brought about federal attempts to prohibit euthanasia but the Supreme Court overturned these laws and left such regulations to the states. Today, doctors have been left with a great deal of personal discretion. However, because of the patient's rights movements of the 1970s, rather than the involuntary euthanasia of the past, it is now more common for the withholding of treatment to be authorized by advanced directives. Nevertheless, as Pernick reveals so well, controversies that divided America in 1910 remain to trouble us as we argue questions about quality of life and how it may be achieved. He shows how such questions are complicated by new discoveries in genetics and advances in bioengineering, as we continue to confront perplexing issues of science and morality, life and death.
Lori Arviso Alvord, M.D., and Elizabeth Cohen Van Pelt, The Scalpel and The Silver Bear, Bantam Books, 2000. Reviewed by Harvey Fenigsohn.
Location: History of Medicine & Health Care Collection; Humanities in Medicine Collection
Call Number: WZ 100 A476s 2000
In The Scalpel and the Silver Bear, Lori Arviso Alvord relates the inspiring story of her life as she became the first Navajo woman surgeon. Never forgetting her native roots, Dr. Alvord strongly advocates blending western medicine with the traditional healing of the Navajos. She reveals how Native Americans' almost miraculous curative practices transcend the limitations of today's medical science with its dominant emphasis on pathology and technology. We learn that modern medicine has much to gain from the spiritual values of an ancient people.
The daughter of a white mother and an Indian father, Dr. Alvord's childhood in New Mexico straddled both worlds, but she seems to have responded most deeply to her Navajo heritage. In this moving, compelling autobiography, we follow her from her earliest days on the reservation to her undergraduate years at Dartmouth and on to Stanford for medical school and residency. Dr. Alvord then went home to the reservation as a surgeon at Gallup Indian Medical Center, determined to better the lives of her people. She currently practices at Dartmouth Medical School and serves as Associate Dean of Student and Multicultural Affairs and Assistant Professor of Surgery and Psychiatry.
Bright and ambitious, Lori Arviso originally left New Mexico to attend college on a scholarship. As a woman and as a Native American, she felt doubly alienated, but found comfort with the few Native American classmates at Dartmouth. She learned to overcome the Navajo's characteristic reticence and reserve, distinguishing herself academically and gaining admission to Stanford's prestigious medical school where she completed her surgical training. Again finding herself in the minority--an Indian woman in general surgery--she more than proved herself by becoming chief resident in a field traditionally dominated by white males. Returning home, she dedicated herself to merging the medical expertise of a skilled surgeon with the holistic medicine of a native healer.
At Gallup, she encountered patients reluctant to establish eye contact, fearful of being touched, resistant to having organs removed from the body - in short, thoroughly intimidated by Dr. Alvord's modern methods. She soon realized that only by winning her patients' trust could she really be most effective. She learned to approach them gradually, to establish her credibility as a fellow Indian, and always to respect their native beliefs. Dr. Alvord explained how the Indians strive to live a life in harmony with the natural world. Concerned with the whole being of a person, tribal medicine is based on a healing philosophy called "Walking in Beauty." The Navajos sensed their mystical connection with the universe, seeking a balance of body, mind, and spirit.
With this wisdom, Dr. Alvord convinces us that there is more to medicine than science. From her, for example, we learn the power of song in healing. When an old man was sick in the Gallop hospital with cancer, a hataali, or medicine man, performed a "sing," a ceremony of chanting. The elderly Indian was being treated with chemotherapy, radiation, and surgery, but he began to show signs of recovery only after the trusted shaman sang at his bedside. The medicine man gave his patient something modern medical science could not provide - hope.
Dr. Alvord is quite aware that today's physicians might well dismiss such unscientific practices, considering them to be based on ignorance and superstition. She is not advocating that modern medicine adopt the healing rituals and ceremonies of the Navajo. Instead, she emphasizes how native medicine provides a model of personal care far too often missing from today's hospitals and doctors' offices. As she writes:
Now, more than ever, patients themselves feel removed and forgotten, powerless in the face of the institutions that were created to help them ... modern medicine has become a one-way system - from physicians to patient. Physicians do the directing, talking at their patients ... listening on the part of the physician is becoming lost ... Patients want to be involved ... They want to feel more than a set of organs and bones, nerves and blood, and participate in restoring their bodies to health.
As a surgeon at the reservation hospital and later, as a medical school professor at Dartmouth, Dr. Alvord has stressed the need for physicians to respect the emotional and spiritual needs of their patients as well as their physical requirements. For her, the ideal hospital would combine state-of-the-art technology with a serene, warm, and comfortable setting, one with natural light and free of the harsh, sterile, clinical atmosphere of so many modern facilities. She points out that respected medical journals report the benefits of community and spirituality in reducing patients' mortality and promoting their healing.
In speaking out, Dr. Alvord's voice has been heard. Her memoir is now read in many undergraduate and medical school courses, and is popular with reading groups around the country. In demand as a speaker, Dr. Alvord has garnered numerous honors including two honorary degrees and an Outstanding Women in Medicine award. In her life and in her spirit, Lori Arviso Alvord is indeed a woman who demonstrates what it means to "Walk in Beauty."
Dr. Alvord spoke at UMass Medical School on May 21, 2008. For a report on her presentation, please see page 16 of the September-October 2008 issue of Worcester Medicine.
Robert N. Proctor, The Nazi War on Cancer. Princeton University Press, 1999. Reviewed by Harvey Fenigsohn.
Location: Book Collection (1st floor)
Call Number: WA 11 GG4 P799n 1999
In The Nazi War on Cancer, historian Robert Proctor asks how a nation responsible for so much death could nevertheless make outstanding contributions to the preservation of life. In this subtle, nuanced study, written in an engaging, lucid style, Proctor uncovers what he calls "the 'flip side' of fascism" (277). He discloses the hitherto little-known fact that Hitler's followers, despite all of their unforgivable crimes against humanity, implemented highly enlightened public health measures, making unprecedented advances in toxicology and epidemiology. In analyzing this paradox, he raises profound moral questions we have yet to answer. What are we to make of a nation that justified castrating thousands of "defectives," conducted sadistic medical experiments, and systematically executed millions, yet pioneered health reforms we now emulate? Concentrating on one disease, he explains that the Nazis viewed cancer as more than an organic illness. Rather, for Hitler's Germans, cancer was a metaphor for all the racial and cultural impurities they intended to eradicate in order to establish their fascist utopia.
To achieve their goals, the Germans were determined to recreate their society, and in many ways they made significant and even admirable efforts to achieve a healthy populace. Proctor asserts that the Nazis established health programs that "today we might regard as 'progressive' or even socially responsible" (5). To prove this, he makes use of impressive documentation in both German and English, drawing from both scholarly sources and popular writing.
We learn that the Nazis were dedicated environmentalists, the first to discover the many carcinogenic effects of the workplace. Proctor shows them making strenuous efforts to overcome the occupational hazards of asbestos and radiation, and to reduce the cancerous effects of preservatives, food dyes, and pesticides. Linking lung cancer to smoking, and stomach cancer to drinking, they launched aggressive propaganda against alcohol and tobacco. The Nazis also realized the nutritional advantages of high fiber, urging the consumption of fruits and vegetables and passing laws making bakeries produce only whole grain bread. Indeed, the Fürher himself gave up smoking and was a confirmed vegetarian.
Though he convinces us that the Nazis were ahead of their time in improving public health, Proctor never lets us forget the grotesque barbarism of a society ruthlessly bent on achieving total physical perfection. As in his earlier work, Racial Hygiene (1988), Proctor shows that German medical science often reflected the pathology of racism. He describes the malign research of a truly maniacal scientist, Josef Mengele, the SS doctor of Auschwitz, who injected dyes into the eyes of living subjects to determine if brown eyes could be changed into blue ones. We are reminded that concentration camp victims were immersed in freezing water to measure precisely how long it took a person to die in icy cold conditions. Euthanasia, sterilization, and ultimately the Final Solution of genocide: all were justified as vital to the progress of National Socialism.
Ironically, if not for their political biases and racist fantasies, the Nazis would have made even greater strides in overcoming disease. Jewish physicians and scientists were in the forefront of cancer research. Nevertheless, rather than degrade their society with non-Aryans, the Nazis purged Jews from the medical community, sentencing them to the gas chambers. No pollution, whether racial, religious, or ideological, was to be tolerated if the Übermenschen were to achieve their dream of world domination.
Most interesting is the author's concern with the troubling ethical issues raised by Nazi medical research. He wonders "how the routine practice of science can so easily coexist with the routine exercise of cruelty" (278). He points out that Nazi medical data is often viewed as "tainted," but the Allies nevertheless used this data. In fact, Josef Mengele has a paper listed in Index Medicus. Proctor notes that a widely consulted text on anatomy, the Pernkopf Atlas, made use of cadavers from the death camps.1 He asks us to consider: should this work be suppressed or dedicated to the memory of the victims?
Proctor reminds us that the Nazis were aware of racial segregation in America and that we, too, once sterilized the mentally ill and abusively experimented on human subjects. We are reminded that no society can ignore the ethical implications of their scientific advances. In The Nazi War on Cancer, Robert Proctor makes a significant contribution to medical history and challenges us to think deeply about the complex confluence of politics, science, and morality.
The views and opinions expressed in these reviews are strictly those of the author. Comments and suggestions may be sent to Harvey Fenigsohn.