The Neurological Patient in History

Abstract

134 BOOK REVIEWS continued to demand their availability, even those women given the opportunity to use the more effective diaphragm through the local clinic; ‘In short’, she explains, ‘they just didn’t like the diaphragm and made the decision to use something else.’ (p. 83) Even in the research environment of the 1960s clients were not without agency, making informed decisions to become involved in exchange for free contraceptives and health checks; she did not see the scandal at San Antonia as typical. Holz amply succeeds in her goals of showing the malleable relationship between business and charity, as well as the malleable definitions of birth control and the flexibility in the functioning of local birth control clinics in America. LINDA BRYDER UNIVERSITY OF AUCKLAND Stephen Jacyna and Stephen T. Caspar, eds, The Neurological Patient in History, Rochester Studies in Medical History Series (Rochester, NY: University of Rochester Press, 2012). ISBN 13: 9781580464123 (HC). 4 B&W illustrations, vii + 264pp. This is an interesting book and a useful one, even though it has its limitations, chief among which is the strong odour of residual Foucauldianism that clings to some of its paragraphs. I am always cautious of books where the phrase ‘clinical gaze’ appears on the first page,especiallywhenfollowedupbytheclaimthat‘neurologicaldisease is not an essence waiting to be discovered but rather a construct with a discernible historicity’ (p. 1). Not that there’s anything wrong with this per se, but it is soon followed up by a claim (p. 3) that Reaganism and Thatcherism reconfigured their respective health care systems to recast the ‘patient’ in the role of the ‘client’. They may have meant to do so, and they may indeed have done so in terms of changing the vocabulary, but anyone with any experience as either a practitioner or a ‘client’ in either system will recognise this claim as nonsense. Perhaps it would have been more accurate to argue that in the U.S. the ‘patient’ has been replaced by the ‘litigant’, and in the UK by the ‘complainant’. But these are minor matters, especially when the editors have the good sense to note that even after Roy Porter’s rallying call to place the patient at the centre of the history of medicine, patients’ histories are still ‘curiously underwritten’ (p. 6). Neurology is a good place Health & History ● 15/1 ● 2013 135 to start with individual patient profiles, and British physician and neurologist Oliver Sacks has been well aware of this since at least 1973 when he wrote Awakenings. Sacks has proved that it is possible to share a patient’s story in a way that does not objectify them and which engages the reader while at the same time providing a window into a particular neurological condition. His contribution is in turn ‘curiously underwritten’by Jacyna and Caspar, which is a pity, because it has been significant. The book has five parts, each with two chapters arranged around a particular type of construction: medicine constructing a patient, public and private constructions of a patient, patient groups as agents which construct patients, neurological patients as constructed by patients, and finally historians constructing neurological patients. It’s an intriguing way of looking at the question, and one that for the most part is quite successful. The last section offers a useful historiographical analysis: Roger Cooter’s very brief chapter ‘Neuropatients in Historyland’ is excellent, because he manages to say very coherently in just three pages what the entire book has already tried to do in the previous 211 pages, while Max Stadler’s reflection which follows it is similarly brief and similarly coherent (and also mentions Oliver Sacks). A chapter which particularly stood out for me was Ellen Dwyer’s ‘NeurologicalPatientsasExperimentalSubjects:EpilepsyStudiesinthe United States’, which tackles a painful chapter in medical history and the use of indigents and other vulnerable populations as experimental subjects in the early 1930s as part of the Northwestern Plan project. These unfortunate subjects were put through bizarre batteries of tests including psychosurgery and other forms of surgery, anoxia research (lowering of oxygen levels), water metabolism including dehydration and overhydration, alcohol and the occasionally successful ketogenic diet. While the Tuskegee syphilis study is now a textbook case of...