Saturday, February 28, 2015

THE DOCTORS' PLAGUE by Sherwin Nuland ✮✮✮⭐︎

One of the great truths of science is that in seeking the answer to one question, the greatest discoveries are often made.  It is of such a quest that Sherwin B. Nuland seeks to enlighten his reader in his nonfiction work, The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis.  Nuland writes with passionate enthusiasm about the history of childbed fever and Ignác Semmelweis, the discoverer of its cause, a man all but lost in the annuls of history.  In helping the reader to understand Semmelweis and the importance of his discovery, the author outlines the history of the illness that sparked his single-minded quest for answers and introduces many important medical and political figures of the time.  Informing about the clinical aspects takes precedence, but along the way readers learn a fair amount about the medical culture of the primary setting of the book: Vienna, in the middle of the nineteenth century.
After a lovely narrative telling the tale of a young, pregnant woman dying of childbed fever after the hospital delivery of her child, a fairly comprehensive recitation of the history of childbed fever is given.  Covered are the many people who attempted to dig their way to the root of the devastating illness whose eradication is the central theme of the book.  This information is given in a couple of chapters—one about the earliest postulations and another setting the scene for the medical community which Semmelweis would soon join.  
Finally, the author begins telling the story of Ignás Semmelweis, a young physician, who chose obstetrics after unsuccessfully attempting entrance to more respected fellowships, because he knew he would not face rejection again.  It might be said that fate led Semmelweis, who originally aspired to the practice of law, to the Allgemeine Krankenhaus and thrust his agile, inquisitive mind towards solving a problem that had bedeviled midwives, physicians, and their patients for more than 2,200 years.  It was Ignás Semmelweis who finally drew the first lasting connection between the importance of hand-washing in halting the spread of infection, including that which caused childbed fever, from patient to patient.

What makes Semmelweis’s story so engaging is not only the fact that he solved a medical mystery that had an import stretching beyond hospital delivery rooms.  His story shows the importance of two practices long viewed as necessary in ensuring that discoveries of scientific import are acknowledged as credible: establishing laboratory experiments that can be replicated by others in the field and publishing written accounts of all findings.

Sherwin Nuland does an excellent job highlighting Semmelweis’s resistance to laboratory experiments, which the doctor deemed unnecessary; he felt the recorded drops in mortality rates of childbed fever in hospitals which instituted mandatory hand-washing spoke for themselves.   Another area the author spends even more time discussing is the effect of Semmelweis’s failure to write about his findings.  Semmelweis was very fortunate that he had friends who were well respected within the medical community and wrote on his behalf.  Their enthusiasm for his discovery, however, hurt Semmelweis in the end, because they didn’t adequately cover all 
aspects of his research and a critical detail was neglected.  The other doctors claimed that Semmelweis had found that infection was spread when doctors went into the delivery room, without adequate hand sanitizing, after dissecting corpses of those who died of childbed fever.  They neglected to mention that Semmelweis also discovered that infection transferred from other sources, such as an infected knee and cancerous pus from an infected breast.  This omission caused doctors at hospitals that did not practice autopsies to discount Semmelweis’s theory; since they did not deal with cadavers, their cases of childbed fever could not be attributed to the only cause that Semmelweis apparently espoused.  

While the author writes in a convincing and vivid fashion about the main themes in the book, the book does have a couple of definite weaknesses.  Foremost of them is that the book is in desperate need of a more definitive timeline.  For the vast majority of the book the reader is bounced literally from Before the Common Era into the mid-nineteenth century and back and forth to various times in between.  This structure makes following the process of discovery very challenging.  The second issue that makes the book more challenging than it likely needs to be is that in a couple of chapters right at the beginning of the book the reader is subjected to a very dry, arduous recitation of names, dates, and theories.  The information is necessary to the story but would have gained a more attentive audience if woven in a more anecdotal fashion into the flow of the narrative.

Overall, I definitely feel that the book’s strengths outweigh its weaknesses.  Nuland creates a convincing argument for Semmelweis’s place in history—in the beginning he is a bit too enamored of his protagonist, but he does come round to an honest assessment of his subject in the end, making his opinions seem well-reasoned and valid.  A complete, if disorganized, history of childbed fever is presented in such a way that the book will appeal beyond the reader of medical chronicles.  General history and politics, social issues, women’s studies, and even the psychological make-up of Semmelweis are all interwoven into the narrative, making for a story with broad appeal.

Wednesday, February 11, 2015

MAMA KOKO AND THE HUNDRED GUNMEN by Lisa J. Shannon (✮✮✮✮⭐︎)

Currently, I am doing a multiple year reading challenge through most of the African nonfiction on my TBR, with the addition of a few novels.  Based on the advice of a friend who also enjoys reading nonfiction about The Dark Continent, one of the first books to go on my challenge list was Lisa Shannon’s The Thousand Sisters.  Since my Congo books were slated for next year, I had yet to experience her writing; however, when I was offered a review copy of this, her newest book, I jumped on it.

Lisa had the opportunity to travel to the home village of a friend, a Congo born woman married to an American who served in the Peace Corps in her village.  Francesca’s family’s region had recently become embroiled in the tragic despotic conflict that has been spreading across the borders of several neighboring countries.  Lisa convinced her that they should travel to the area together, with Francesca acting as translator and guide, in order for Lisa to document and then share with the west the continued abuses and trials suffered by the people of the region.

Lisa Shannon is a well-known activist for the women of Congo and has devoted her life to raising awareness of their plight.  As such, I expected an insightful look at the hardships experienced by her subjects, but I was completely unprepared for what an outstanding narrative writer she is.  She brings Congo to sweat-soaked, dust-laden reality.  Its people come vividly to life as she shares their humor under duress, their love for each other, and their despair over the calamity that has descended on their once bucolic corner of Africa.

Mama Koko is primarily the story of Francesca’s family (Mama Koko is her mother) and their reminiscences.  Lisa relates first person interviews, observes the situation at the time of her visit, and shares her insight.  In addition, Lisa is unflinching in her analysis of her own motivations and emotions.  There is an appendix at the end of the book where a brief but very informative history of the descent of Congo into chaos is detailed.  Lisa states that she wanted the focus of the book to be on the family and their experiences, but as someone unfamiliar with the genesis and progression of the conflict, I appreciated her synopsis.

At the conclusion of the book, Lisa gives a list of organizations that aid victims of violence in Congo and encourages readers to learn more about their critical efforts.  There is also a listing of all the people mentioned in the book and a distinguishing characteristic.  My guess is that list will be moved to the front of the final publication, but if not, be aware that it is in the back and rather useful while you read, as there is a large cast of players in the narrative.  Although they were not included in my galley, it looked as though there are going to be a significant number of maps in the finished product, which has been available for purchase since 3 February.

Chronology was the sole reason that this book did not garner five stars from me—I gave it a solid four and a half in places that allow halves.  Lisa gives a linear narration of her interviews in the order she conducted them, along with her own experiences, as opposed to the order in which the events being recounted happened.  At times, I lost my grasp of how the many occurrences slotted together.

That single gripe aside (and truly, it in no way affected the impact of the story Lisa was trying to tell), I would recommend this book to anyone who seeks to better understand the non-combatant viewpoint of a region in violent crisis.  This story is not told as a journalist might report the conflict.  It is the chronicle of one motivated, compassionate woman driven to share the anguish of families caught in the cross-fire of a tumultuous battle which came unbidden to their doorstep and which they have never embraced as their own.  This is a book aimed at encouraging each of us to engage, both on an emotional and a hands-on level, in one of the great tragedies of our time.