The Healer's Tale By Sharon R. Kaufman (review)

Abstract

BOOK REVIEWS TL· Healer's Tale. By Sharon R. Kaufman. Madison: Univ. Wisconsin Press, 1993. Pp. 354. $27.50. In the prologue of this interesting book, Sharon Kaufman points out that "medicine has traditionally manipulated nature in its attempt to prevent or intervene in the ravages of disease." "More recently medicine has also begun to transform culture with its increasing power to manipulate natural processes." In particular, she cites, as a consequence of advancing medical technology, the changing views of life, death, and motherhood. "The confusion generated by the blurring of traditional boundaries between culture and nature permeates our national consciouness." She affirms that "medicine's ends . . . are not based on a consideration of what or how much, or when, or for whom technological intervention and the saving and managing of lives is appropriate." Kaufman asks: "How and why did this problem arise?" In an effort to answer this and related questions she examines how these developments were experienced by seven outstanding physicians, whom she selected to interview not only for their personal qualities but also because they were trained "before antibiotics and the world of high-tech ... I wanted to know how social values, expectations, and attitudes, as well as scientific ideas, diseases, and treatments shaped their careers and changed over decades." Four of the seven doctors were university-based, three full-time. Six were men and one a woman. They all came from middle-class families and among other qualities shared "... a deep compassion and kindness for their patients." They were Drs. Paul B. Beeson of Seattle, C. Paul Hodgkinson of Detroit, Saul Jarcho of New York, Mary B. Olney of San Francisco, Jonathan Rhoads of Philadelphia, John Romano of Rochester, New York, and J. Dunbar Shields of Concord, New Hampshire. The first part of the book focuses on "medical morality" and describes the important role of the family in shaping the character, and sense of responsibility in each of the seven doctors. In four instances, physician fathers served as role models. The parents of the other three were involved in community activities. The orientation of medicine in the 1920s and 1930s was mostly towards general practice. The clinical setting usually was in large charity hospitals: Shields in Charity Hospital, New Orleans, and St. Lukes Hospital, New York; Jarcho in Mt. Sinai Hospital, New York; Beeson and Rhoads at the University of Pennsylvania, Philadelphia; Olney at San Francisco General Hospital; Hodgkinson at the Philadelphia General Hospital; and Romano at the Milwaukee General Hospital. The Permission to reprint a book review printed in this section may be obtained only from the author. 460 Book Reviews internship of the 1930s differed greatly from today. "No one was married. No one had money for entertainment outside the hospital. There was no salary. They did not leave the hospital often, yet they shared an intense, exclusive experience." Medicine during the 1920s and 1930s was characterized by the primacy of physical diagnosis, charity patients who were lucky to have care, a sense of public duty and personal empathy coupled with a feeling of social distance, lack of explanation to patients and families, potentially lethal infectious diseases for which there was no cure, hope invested in medical research and finally, certainty that the natural progress of the disease determined medical outcome. All seven physicians became specialists: Shields and Jarcho in internal medicine but without formal specialty training; Beeson, after a stint as general practitioner , trained in internal medicine; Romano, psychiatry; Rhoads, surgery; Hodgkinson, gynecological surgery and obstetrics; and Olney, interested initially in orthopedics, settled on pediatrics. Science as well as clinical care contributed to the development of the young physicians. For Beeson, a key experience was a two-year residency at the Rockefeller Institute, and a major clinical influence came from Soma Weiss at the Peter Bent Brigham Hospital. For Olney it was two years at UCSF and another year at Bobs Roberts Memorial Hospital (University of Chicago); for Rhoads, his mentor I. S. Ravdin, University of Pennsylvania; for Hodgkinson, the experience with J. P. Pratt at the Henry Ford Hospital; and for Romano, training at Yale, University of Colorado, and the Harvard service of the Boston City Hospital, the positions held and their...