Competent physicians make accurate diagnoses. How are accurate diagnoses made? This readable book gives some important answers to that question. Experienced physicians were presented with diagnostic problems and asked to solve them. Through the use of trained actors serving as “patients” and with a variety of supplementary techniques, the investigators were able to dissect the process by which diagnoses, right and wrong, are made.

Reporting on the most comprehensive investigation of clinical reasoning yet conducted, the authors present data and conclusions of importance not just to medical educators but to anyone interested in the psychology of problem solving. Rigorous attention to methods, thorough grounding in contemporary theories of problem solving, and a healthy respect for the complexity of real-life situations characterize this remarkable study.

A sampling of its salient findings only suggests the richness of this book. Successful diagnosticians begin to form hypotheses almost as soon as they encounter a patient. They entertain a limited number of hypotheses, but these are tested repeatedly during a workup. New findings are treated as confirming, refuting, or not contributing to the solution contemplated; more elaborate schemes based on a knowledge of probabilities are not used. A common error is to relate new information to a working hypothesis, although the information is, in fact, non-contributory. The performance of even an experienced physician varies markedly from case to case. Two of the most important determinants of competence are information and experience; problem-solving skills without a rich supply of facts are insufficient for diagnostic acumen.

A personal account of the aging body and advanced technologies by a preeminent philosopher of technology

Medical Technics is a rigorous examination of how medical progress has modified our worlds and contributed to a virtual revolution in longevity. Don Ihde offers a unique autobiographical tour of medical events experienced in a decade, beginning in his 70s. Ihde offers experiential and postphenomenological analyses of technologies such as sonography and microsurgery, and ultimately asks what it means to increasingly become a cyborg. 

Runaway medical costs, long-term care, market competition, for-profit medicine, nursing shortages—these are but a few of the issues that swirl around in the late twentieth century’s volatile health care scene. How much of the system do we want to change, and how much do we want to keep? Health policy expert Eli Ginzberg examines such crucial questions in his characteristically broad-gauged perspective. Framing the issues in their historical, political, and professional contexts, the author analyzes how we have arrived at the current crisis.

The book focuses on the three sides of the medical triangle that have separate and sometimes conflicting goals: the physicians want to provide the most health care for the most money; the government, which furnishes 40 percent of the system's funding, wants to limit the money it pays out for health care; and the public, with over a billion annual visits to doctors, wants the most health care for the least money.

Ginzberg explains how the core components of our health care system—the community hospital and physicians who have long practiced in a fee-for-service mode—are under attack, and he indicates the factors that make it uncertain whether the destabilization will slow down or accelerate. Moreover, can key health care centers maintain their leadership in a time when new dollars for health are scarce? How will the floundering state of foundations affect medical care in local communities?

In his final chapters the author zeroes in on the special concerns of the public: high-need patients (including those suffering from cancer, catastrophic illness, and the infirmities of old age, or those who are mentally ill or chronically poor), nursing shortages, unsuccessful cost containment, and lack of consensus within the medical triangle about the major issues on our nation's health agenda.

The first comprehensive edition and translation of Old English writings on health and healing in more than 150 years.

Unlike elsewhere in Europe, vernacular writings on health and healing had a major place in early medieval England. These texts—unique local remedies and translations of late antique Latin treatises—offer insights into the history of science and medicine, social history, scribal practices, and culture. Some cures resemble ones still used today; others are linguistically extravagant, prescribing ambitious healing practices. Alongside recipes for everyday ailments such as headaches are unparalleled procedures for preventing infant mortality, restoring lost cattle, warding off elf-shot, or remedying the effects of flying venom.

Medical Writings from Early Medieval England presents the first comprehensive edition and translation from Old English of these works in more than 150 years. Volume I includes The Old English Herbal, Remedies from Animals, Lacnunga, the Peri Didaxeon, and a compendium of miscellaneous texts.

In 1537, Florentine Duke Alessandro dei Medici was murdered by his cousin and would-be successor, Lorenzino dei Medici. Lorenzino's treachery forced him into exile, however, and the Florentine senate accepted a compromise candidate, seventeen-year-old Cosimo dei Medici. The senate hoped Cosimo would act as figurehead, leaving the senate to manage political affairs. But Cosimo never acted as a puppet. Instead, by the time of his death in 1574, he had stabilized ducal finances, secured his borders while doubling his territory, attracted an array of scholars and artists to his court, academy, and universities, and, most importantly, dissipated the perennially fractious politics of Florentine life.

Gregory Murry argues that these triumphs were far from a foregone conclusion. Drawing on a wide variety of archival and published sources, he examines how Cosimo and his propagandists successfully crafted an image of Cosimo as a legitimate sacral monarch. Murry posits that both the propaganda and practice of sacral monarchy in Cosimo's Florence channeled preexisting local religious assumptions as a way to establish continuities with the city's republican and renaissance past. In The Medicean Succession, Murry elucidates the models of sacral monarchy that Cosimo chose to utilize as he deftly balanced his ambition with the political sensitivities arising from existing religious and secular traditions.

In these essays, a diverse group of ethicists draw insights from both religious and feminist scholarship in order to propose creative new approaches to the ethics of medical care. While traditional ethics emphasizes rules, justice, and fairness, the contributors to this volume embrace an "ethics of care," which regards emotional engagement in the lives of others as basic to discerning what we ought to do on their behalf.

The essays reflect on the three related themes: community, narrative, and emotion. They argue for the need to understand patients and caregivers alike as moral agents who are embedded in multiple communities, who seek to attain or promote healing partly through the medium of storytelling, and who do so by cultivating good emotional habits. A thought-provoking contribution to a field that has long been dominated by an ethics of principle, Medicine and the Ethics of Care will appeal to scholars and students who want to move beyond the constraints of that traditional approach.

The colonial encounter between France and Morocco took place not only in the political realm but also in the realm of medicine. Because the body politic and the physical body are intimately linked, French efforts to colonize Morocco took place in and through the body. Starting from this original premise, Medicine and the Saints traces a history of colonial embodiment in Morocco through a series of medical encounters between the Islamic sultanate of Morocco and the Republic of France from 1877 to 1956.

Drawing on a wealth of primary sources in both French and Arabic, Ellen Amster investigates the positivist ambitions of French colonial doctors, sociologists, philologists, and historians; the social history of the encounters and transformations occasioned by French medical interventions; and the ways in which Moroccan nationalists ultimately appropriated a French model of modernity to invent the independent nation-state. Each chapter of the book addresses a different problem in the history of medicine: international espionage and a doctor’s murder; disease and revolt in Moroccan cities; a battle for authority between doctors and Muslim midwives; and the search for national identity in the welfare state. This research reveals how Moroccans ingested and digested French science and used it to create a nationalist movement and Islamist politics, and to understand disease and health. In the colonial encounter, the Muslim body became a seat of subjectivity, the place from which individuals contested and redefined the political.

A witch doctor casting an evil spell in a steaming jungle village; a young medical-school graduate cleaning a machete wound in a rat-infested thatched hut; a world-renowned scientist doing research in Mexico City—all were part of the mid-twentieth century medical scene in Mexico, a country of great cultural, socioeconomic, and geographical contrasts.

Gordon Schendel, in collaboration with Dr. José Alvarez Amézquita and Dr. Miguel E. Bustamante, relates the history of medicine and public health and welfare in Mexico. This absorbing story begins with a great indigenous culture; continues with Spanish Colonial rule, the unproductive first century of independence from Spain, and the years of revolution; then concentrates on the modern nation.

The Aztec civilization evidenced a knowledge of pharmacology and the fundamentals of health far in advance of contemporary European societies. And almost one hundred years before the Pilgrims landed on Plymouth Rock, New Spain boasted a comprehensive "Public Health Administration" and a hospital system that served all classes. However, throughout Mexico's three centuries as a Spanish colony and its first century of independence, millions of its citizens suffered abysmal poverty. Thus when the Republic of Mexico entered its post-Revolutionary era, the majority of its citizens were plagued by superstition, illiteracy, malnutrition, and the other "diseases of the poor."

The principal part of this story tells how Mexico attacked these problems, and how in a few short years it became a leader and a model for all Latin America in the fields of medicine and public health and welfare. The book is based on Mr. Schendel's research and observations and on his many interviews with doctors and govemment officials. It will be of interest to the medical profession and to concerned laymen of all nationalities, for it illustrates how a dynamic nation met challenges that all countries of the world, developed and underdeveloped, must face.

At the temple of Kom Ombo near Aswan, an enigmatic frieze depicts the deified pharaoh Imhotep receiving a set of elaborate implements, some of which strikingly resemble modern surgical instruments: side by side with eye-of-Horus amulets one finds what surely must be forceps. Evidence of the medical practice of ancient Egypt has come down to us not only in pictorial art but also in papyrus scrolls, in funerary inscriptions, and in the mummified bodies of ancient Egyptians themselves.

Bruno Halioua and Bernard Ziskind provide a comprehensive account of pharaonic medicine that is illuminated by what modern science has discovered about the lives (and deaths) of people from all walks of life--farmers, fishermen, miners, soldiers, scribes and priests, embalmers, construction workers, bakers, prostitutes. From mummies and medical papyri we are able to recognize the aches of osteoarthritis, imagine the occupational hazards faced by press-ganged stonemasons, and learn of the gynecological complaints of courtesans. In presenting these stories Halioua and Ziskind throw light on some of the most enduring questions about life and death in antiquity: about physicians whose skills predate Hippocrates by twenty-five centuries and were first made famous by Homer; about the remedies and techniques they employed, at once strange and strangely familiar; about the men, women, and children they treated; and about the diseases and injuries they were called upon to heal.

"People who live in California deny the past," asserts Alejandro Murguía. In a state where "what matters is keeping up with the current trends, fads, or latest computer gizmo," no one has "the time, energy, or desire to reflect on what happened last week, much less what happened ten years ago, or a hundred." From this oblivion of memory, he continues, comes a false sense of history, a deluded belief that the way things are now is the way they have always been.

In this work of creative nonfiction, Murguía draws on memories—his own and his family's reaching back to the eighteenth century—to (re)construct the forgotten Chicano-indigenous history of California. He tells the story through significant moments in California history, including the birth of the mestizo in Mexico, destruction of Indian lifeways under the mission system, violence toward Mexicanos during the Gold Rush, Chicano farm life in the early twentieth century, the Chicano Movement of the 1960s, Chicano-Latino activism in San Francisco in the 1970s, and the current rebirth of Chicano-Indio culture. Rejecting the notion that history is always written by the victors, and refusing to be one of the vanquished, he declares, "This is my California history, my memories, richly subjective and atavistic."

In Medicine Show, inner conflict is wonderfully realized in the clash of down-home plain speech and European high culture utterances. Freely translating and adapting Catullus (Latin), Villon (Middle French), Corbiere (French), Hikmet (Turkish), and Orpheus (Greek), and placing them alongside Jagger and Richards, skinheads, and psalms, Tom Yuill’s book mirrors an old-style hawking of wares, with all the charm and absurdity that results when high culture meets pop, when city meets small town, and when provincialism confronts urbanity. Here, the poems talk to one another, one poem nudging the cusps of many others, those poems touching still others' circumferences. Yuill, by invoking the Rolling Stones as muses and as background music, offers cover versions of Shakespeare, Keats, and Dylan Thomas, ultimately giving us a new kind of verse, funneled through the languages and rhythms of his masters' voices.

How is medicine doing at the end of the twentieth century? While there has been no end of studies of our health care system and proposals for changing it, there have been few credible studies of the risks and benefits of widely used medical treatments. We simply do not always know whether one treatment is better than another or whether a particular drug is worth the price.

Medical technology assessment is the discipline that studies what does and does not work in medicine. Howard Frazier and Frederick Mosteller are leading figures in this field. In Medicine Worth Paying For they attempt something completely new: to distill the methods and knowledge base of their highly specialized discipline into a text that is accessible—and therefore of great value—to a nontechnical audience.

This book calls attention to the importance of technology assessment in medicine—the rigorous evaluation of the effects of medical treatments—with particular reference to medical innovations. Also, making use of a series of carefully selected cases, the authors identify important policy implications that can be drawn from the study of successful medical innovations. These case studies of medical successes are a rich source of examples of the effects, good and bad, of the application of technology to health care and of attempts to influence the diffusion of technologies in health care.

Medicine Worth Paying For should be of interest to a variety of readers, particularly those concerned with health policy, investigators studying health services, those in the health professions, nonprofessionals who wish to maintain and improve the performance of the health care system, and others who simply want a system that provides benefits greater than risks at an acceptable financial cost.

How should the medieval family be characterized? Who formed the household and what were the ties of kinship, law, and affection that bound the members together? David Herlihy explores these questions from ancient Greece to the households of fifteenth-century Tuscany, to provide a broad new interpretation of family life. In a series of bold hypotheses, he presents his ideas about the emergence of a distinctive medieval household and its transformation over a thousand years.

Ancient societies lacked the concept of the family as a moral unit and displayed an extraordinary variety of living arrangements, from the huge palaces of the rich to the hovels of the slaves. Not until the seventh and eighth centuries did families take on a more standard form as a result of the congruence of material circumstances, ideological pressures, and the force of cultural norms. By the eleventh century, families had acquired a characteristic kinship organization first visible among elites and then spreading to other classes. From an indifferent network of descent through either male or female lines evolved the new concept of patrilineage, or descent and inheritance through the male line. For the first time a clear set of emotional ties linked family members.

It is the author’s singular contribution to show how, as they evolved from their heritages of either barbarian society or classical antiquity, medieval households developed commensurable forms, distinctive ties of kindred, and a tighter moral and emotional unity to produce the family as we know it. Herlihy’s range of sources is prodigious: ancient Roman and Greek authors, Aquinas, Augustine, archives of monasteries, sermons of saints, civil and canon law, inquisitorial records, civil registers, charters, censuses and surveys, wills, marriage certificates, birth records, and more. This well-written book will be the starting point for all future studies of medieval domestic life.

This work explores the role of orality in shaping and evaluating medieval Icelandic literature. Applying field studies of oral cultures in modern times to this distinguished medieval literature, Gísli Sigurðsson asks how it would alter our reading of medieval Icelandic sagas if it were assumed they had grown out of a tradition of oral storytelling, similar to that observed in living cultures.

Sigurðsson examines how orally trained lawspeakers regarded the emergent written culture, especially in light of the fact that the writing down of the law in the early twelfth century undermined their social status. Part II considers characters, genealogies, and events common to several sagas from the east of Iceland between which a written link cannot be established. Part III explores the immanent or mental map provided to the listening audience of the location of Vinland by the sagas about the Vinland voyages. Finally, this volume focuses on how accepted foundations for research on medieval texts are affected if an underlying oral tradition (of the kind we know from the modern field work) is assumed as part of their cultural background. This point is emphasized through the examination of parallel passages from two sagas and from mythological overlays in an otherwise secular text.

The medical tradition that developed in the lands of Islam during the medieval period (c. 650-1500) has, like few others, influenced the fates and fortunes of countless human beings. It is a story of contact and cultural exchange across countries and creeds, affecting many people from kings to the common crowd. This tradition formed the roots from which modern Western medicine arose. Contrary to the stereotypical picture, medieval Islamic medicine was not simply a conduit for Greek ideas, but a venue for innovation and change.

Medieval Islamic Medicine is organized around five topics: the emergence of medieval Islamic medicine and its intense crosspollination with other cultures; the theoretical medical framework; the function of physicians within the larger society; medical care as seen through preserved case histories; and the role of magic and devout religious invocations in scholarly as well as everyday medicine. A concluding chapter on the "afterlife" concerns the impact of this tradition on modern European medical practices, and its continued practice today. The book includes an index of persons and their books; a timeline of developments in East and West; and a section on further reading.

Medieval Joke Poetry examines the intersection of jokes, laughter, insults, and poetry in a collection of thirteenth- and fourteenth-century medieval Iberian songs known as the Cantigas d’escarnho e de mal dizer. Written in Galician-Portuguese, these “songs of mockery and insult” make up a heterogeneous corpus whose witticisms are by turns funny and vicious, crudely obscene and exquisitely sophisticated, playful and deadly serious.

Benjamin Liu’s readings disentangle the complex verbal strategies of these joke-poems in order to reveal the latent cultural tensions that underlie their humor. Wordplay, double meanings, and deliberate combinations of incongruous ideas are intended to elicit laughter, even as they gesture toward the rupture of accepted cultural categories in such manifestly hybrid paradoxes as an “Albardan cavaleiro” (noble buffoon), a “mouro cruzado” (Crusader Moor), or a male “dona salvage” (wild woman). Liu shows how these jokes operate in such varied cultural contexts as the arts of augury and divination, pilgrimage, prostitution, interfaith sexuality, and medical malpractice.

We don’t usually think of haute cuisine when we think of the Middle Ages. But while the poor did eat a lot of vegetables, porridge, and bread, the medieval palate was far more diverse than commonly assumed. Meat, including beef, mutton, deer, and rabbit, turned on spits over crackling fires, and the rich showed off their prosperity by serving peacock and wild boar at banquets. Fish was consumed in abundance, especially during religious periods such as Lent, and the air was redolent with exotic spices like cinnamon and pepper that came all the way from the Far East.

Throughout the Middle Ages, Christians wrote about Islam and the life of Muhammad. These stories, ranging from the humorous to the vitriolic, both informed and warned audiences about what was regarded as a schismatic form of Christianity. Medieval Latin Lives of Muhammad covers nearly five centuries of Christian writings on the prophet, including accounts from the farthest-flung reaches of medieval Europe, the Iberian Peninsula, and the Byzantine Empire. Over time, authors portrayed Muhammad in many guises, among them: Theophanes’s influential ninth-century chronicle describing the prophet as the heretical leader of a Jewish conspiracy; Embrico of Mainz’s eleventh-century depiction of Muhammad as a former slave who is manipulated by a magician into performing unholy deeds; and Walter of Compiègne’s twelfth-century presentation of the founder of Islam as a likable but tricky serf ambitiously seeking upward social mobility.

The prose, verse, and epistolary texts in Medieval Latin Lives of Muhammad help trace the persistence of old clichés as well as the evolution of new attitudes toward Islam and its prophet in Western culture. This volume brings together a highly varied and fascinating set of Latin narratives and polemics never before translated into English.