Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

Friday, April 29, 2011

The Great Mortality: An Intimate History of the Black Plague The Most Devastating Plague of All Time



The Great Mortality:
An Intimate History of the Black Plague
The Most Devastating Plague of All Time
By John Kelly

Before you read this blog post, I need to confess that I am both a nerd and a dork. I am also petty and vengeful. Trust me, it will help you understand.

I attended university in the mid-1990s. My major was history and my focus of interest was primarily nineteenth and early twentieth century European history. You know, the post-Napoleonic period, the Quadruple Alliance and the slow, painful march toward World War I. It's a fascinating period in history and perhaps my favorite. I read a lot of material on this period, even today.

I might favor nineteenth century history, but my true obsession are the Middle Ages. I have a twisted fascination with pre-modern Europe. Perhaps it has something to do with the fact that medieval Europe was a superstitious, shit-covered backwater. How does a population that bathed an average of once or twice a decade go on to dominate the planet? It baffles.

Anyhow, I took any course available to me on medieval history and read voraciously on the topic. You want to talk about William the Bastard's Norman Invasion of 1066? I'm your man. You want to wax intellectual about the Carolingians and Merovingians, I can do that. If you want to discuss the implications of the longbow on the history of warfare, I'm in. And if you want to talk the Black Death of 1348-1352, prepare for a long night.

Everyone has their little pet obsessions. Civil War reenactments, Dungeons and Dragons, conspiracy theories, fruity beer... whatever. From an early age, mine has been the bubonic plague that ravaged Europe in the 14th century and wiped out between a third and a half of the entire population of the continent. For as long as I can remember I've devoured books on the topic. I think a lot of it began with the visual representations of the plague. The ubiquitous angel of death reaping lives with impunity across the European countryside, scythe in hand, smiling its skeletal smile of death. they were the sorts of images that any kid would find both disturbing and ultimately fascinating.

The Great Mortality by John Kelly may not be the definitive scholarly work on the topic, but it comes damned close and has the added bonus of being completely readable, unlike so much non-fiction. But I don't want to simply review this work. I want to tell a story that is relevant to my reading of this book.

Back in my third year of university I wrote a paper on the Black Death for my third year medieval history class. Unlike papers for my other classes, I actually started this paper weeks in advance and finished it days prior to the due date (with everything else, I started two days before and finished mere minutes before the start of class). My thesis was essentially that the Black Death was a major catalyst in the emerging enlightenment in Europe. The depopulation of the continent directly caused many of the factors that would bring about events such as the Reformation, the re-discovery of America and the revolutions that would sweep Europe into the modern age.

I'm not going to rehash all my points but essentially I argued that demographics and the collective conscience of Europe fundamentally shifted in response to the sheer magnitude of death that occurred in such a short time (and would periodically reoccur over the next three centuries). The manner in which people died, with such indignation and indiscrimination rattled the faith of many Christians (and Muslims), sparking the doubt that would culminate with the 95 theses and the rise of Protestantism. The helplessness of the medical profession at the time spurned doctors into action over the proceeding centuries, forcing them out of the barber shops and into the laboratories in order to get on with the discovery of the scientific method. And the depopulation of the continent put manual labor at a premium, so much so that many serfs and vassals were able to demand more for their services, giving the under-privileged a lifestyle previously unknown to them and a tantalizing taste of a better life. One worth fighting for. Europe would never be its same pastoral self again.

It was a damned good paper and I was careful to back up my claims factually as best I could given that I was suggesting a fairly controversial idea.

On the day in which the papers were handed back the TA stood at the front of the room and derided the entire lecture hall full of students about the poor quality of the papers. He noted that only a handful of papers were of any substance and most were not acceptable from university level history students. If any of us had views toward post-graduate work, we'd best learn how to write a paper. Naturally, I didn't think he was talking about me. I had written the best damned paper I had ever written. Surely I was one of the handful with substance.

The TA continued: "One paper in particular tried to assert that the Black Death was the cause of the Enlightenment."

The class let out a muffled giggle.

My heart crept into my throat. I'm not sure if any noticed, but I turned seven shades of red, then green... then white. I didn't hear anything else the TA said. It was like the air of my entire university career had been let out of me. I recall my paper landing in my lap and noting the 52% scrawled on the top. I'm sure there were comments, but I don't recall reading them. I was simply devastated.

(Not to worry. I finished my degree and I still maintain my love for medieval history and the Black Death in particular)

Flash forward to this past week. Kelly deftly chronicles the history of Y. Pestis from its birth as a marmot disease on the central Eurasian steppe, it's journey west to the Crimea then into Europe via Genoese merchant vessels. I especially enjoyed the way in which Kelly personified the plague as an invading army akin to the Mongols who had ravaged their way through to Hungary a century prior and whose empire facilitated the spread of the disease. But something struck me about the book as I made my way through it. I couldn't help but notice that John Kelly skirted dangerously close to the same points that got me in so much trouble years ago.

In fact, by the time Kelly reached his conclusions, he was actively postulating all of the points that had been my scholastic de-pantsing and I was reading with my mouth agape. While he stopped just short of actually typing the words: "The Black Death was a major catalyst in the impending European Enlightenment," he may as well have wrote them. He linked the Black Death to the rise of the scientific method, the demand for the printing press, the end of serfdom, the rise of the middle class and the disillusionment with the Christian (soon to be Catholic) church.

This is exactly what I was saying, T.A. Guy! See that!?!? John Kelly wrote a book about it. A good one, too! And where are you now, T.A. Guy? You are probably a stuffy, know-it-all professor in some dusty office at the University of Who Cares surrounded by your antiquated medieval tomes dismissing the Black Death as a historical speed bump. You were wrong, T.A. Guy. I was onto something. Something big (in the world of medieval history, of course). Something important. Something ground-breaking.

A decade and a half later, I feel so very vindicated.

Fuck you, T.A. Guy.

(Great book. Read it.)

Sunday, April 24, 2011

Cutting For Stone



Cutting For Stone
By Abraham Verghese

I have a Doogie Howser reading complex as of late. According to the books I read, teenage surgeons are far more common than I have been lead to believe. First there was Homer Wells in The Cider House Rules and now Marion and Shiva Praise in Abraham Verghese's opus Cutting For Stone. Who would have thought that performing life and death procedures could be so flippantly possible for those suffering from low self-esteem and acne.

But I digress.

Cutting For Stone is an epic story of two generations of expatriate doctors living and working at a mission hospital in Addis Ababa in Ethiopia. The novel is actually quite sweeping and provides a wonderful insight into life during the last years of Selassie's reign and the tumultuous years of Mengistu's dictatorship (not to mention the uncertainty of the Eritrean and Tigre independence movements occuring in the background). Verghese is an adept novelist who knows exactly where, when and how much information to divulge to the reader throughout but is also careful to remind readers along the way about key ingredients that cannot be forgotten along the way. I enjoyed the way he constructed such flawed, fragile characters and his ability to describe specific forms of surgery is borderline grotesque. Verghese reminded so much of Salman Rushdie at times that I had to check the cover to make sure I hadn't picked up The Moor's Last Sigh by mistake.

Cutting For Stone, like so many novels I have read this year, really concerns itself with time and love, our lack of time and the way we as humans fritter it away on things we assume are meaningful, much to the detriment of love. This notion is best represented in the relationships between the narrator, Marion Stone, his (formerly conjoined) twin brother Shiva and their childhood friend Genet. One uses time, another abuses it the third lives as if it doesn't exist at all. This, as one can imagine, complicates their relationships immensely as they grow up and enter the world for adults. This was the central precept of the entire novel for me. As a complete piece of work, Cutting For Stone is quite a rewarding read...

That is, if you can get that far.

Aha!

Considering the plaudits this book has received since its publication in 2009, I might be sticking my neck out by saying this. The problem with this novel, for me, lies in it's first third. It's a minor problem in the grander scheme of the entire book, but it was something that bothered me the entire length of the read. I spent a week reading this book and almost half that time trying to slog my way through the first 150 pages. I hardly ever put a book down, but Cutting For Stone really tested my mettle. I can't recall a novel that eased into the story more slowly.

Verghese sets a pastoral, provincial tone for life in Haile Selassie-era Ethiopia and much of the first third is comprised of plot structures in need of construct for their inevitable culmination. I understand setting up your pins, but things need to keep moving. Furthermore, Verghese spends this portion of the novel delivering a Ondaatje-esque, dream-like narrative of life before the birth of the main character, Marion. All of this together makes for some pretty foggy reading.

There is a (non-spoiler) scene around the 150 page mark that speaks volumes about the pace of this book. Ghosh, one of the resident doctors at the mission (called Missing) hospital is asked to perform voluvus (a blockage in the bowel) surgery on a controvertial army colonel. The surgery is ultimately successful, Ghosh saves the colonel's life and the colonel is able to pass stool once again. I found this bit to be an interesting piece of art-imitates-my-reading.

Perhaps it was my own state of mind during the first few days of reading but it seemed to me that the novel itself had been suffering from a blocked narrative and this little piece of fictionalized surgery removed the blockage and allowed for the story to finally progress unobstructed without asides, tangents or fuzzy pre-birth assumptions. It was only after this scene that I was able to settle into the book and truly enjoy it.

Minor thing, I know and certainly not the sort of thing that should dissuade you from reading this novel, especially if you are interested in Africa, medicine or complicated familial relationships. Ultimately, this book is well worth the effort. Abraham Verghese is a stunningly adept writer of prose and a vibrant new face in the literary world. I'll be on the lookout for his other work in the near future.