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  • Lovers and Livers: Disease Concepts in History
  • Carla C. Keirns
Jacalyn Duffin. Lovers and Livers: Disease Concepts in History. Toronto, University of Toronto Press, 2005. 240 pp., illus. $55 (cloth), $27.50 (paper).

Historians have written about disease for a very long time. Epidemics such as plague and yellow fever have been the focal point of many dramatic narratives, illustrating the structures and fracture points of societies such as Renaissance Venice and colonial Philadelphia. More recently, historians [End Page 230] have focused on more endemic problems, such as mental illness, cancer, and heart disease. Charles E. Rosenberg and Janet Lynne Golden's book, Framing Disease: Studies in Cultural History (New Brunswick, N.J.: Rutgers University Press, 1992), was particularly important in expanding the historical gaze to less spectacular diseases, such as kidney failure, coronary heart disease, and anorexia nervosa.

Duffin has made an important contribution in synthesizing important ideas from Georges Canguilhem, Michel Foucault, Charles Rosenberg, Owsei Temkin, K. Codell Carter, and others into a readable, thoughtful analysis accessible to the general reader or the college undergraduate. The book is divided into three chapters, originating as three lectures in the 2002 Joanne Goodman Lecture series at the University of Western Ontario, which no doubt contributes to their clarity and focus. The first chapter on disease ideas has the broadest mandate, as Duffin explains: "In these pages I will try to convince you that diseases are ideas. You may think of them as scientific puzzles, or as frightening scourges, or as slow, painful torments. I do not want to dissuade you from those views, but I hope you will also see how they can be ideas influenced by the tastes and preoccupations of society" (p. 3). Using a triad of the disease as illness, patient individuality, and observer effects, Duffin constructs a "Hippocratic triangle" and illustrates how heart disease may be seen differently in men and women because of the observer's biases. Alternately, different observers, such as family members, patients, physicians, and religious authorities, may view the same patient-illness dyad quite differently, ascribing different causes and prescribing different treatments.

The two examples, lovesickness and liver disease, illustrate different elements of the construction of diseases. Romantic love, providing fodder for poets, moralists, and physicians since antiquity, becomes a natural subject. Duffin traces the question "Is love a disease?" from Galenic theories and the conjugal cure through modern PET scans and the comparison of brains in the throes of romantic love to those with obsessive compulsive disorder. As Duffin demonstrates, maintaining the boundaries between sickness and health and between natural instincts and moral judgments has occupied many a physician.

Hepatitis is rather a different and more personal story for Duffin. She uses the audience to illustrate the distinction between disease and illness, by asking them who has known someone with jaundice (symptomatic illness) and who has known someone with hepatitis C (a condition that may be silent and can be diagnosed only by a blood test). Duffin explores this historical transition from jaundice to hepatitis through the changes she has seen in her clinical career as a hematologist. As she traces the discovery of the cause for what was once known as "hepatitis non-A, non-B" and the availability of a test for the virus in 1989–1990, we see the importance of [End Page 231] this silent virus for transfusion medicine, both for hematologists who ran blood banks and prescribed blood products, and for the patients who were most dependent upon them, particularly hemophiliacs. The subsequent legal battles over compensation for transfusion recipients, and the difficulties about how to value the silent and healthy hepatitis C carrier versus the person with fatal liver disease, illustrate the life of hepatitis C as a bureaucratic category. Duffin's personal experience with the use of blood factor concentrates in the 1970s and 1980s, when they were known to carry hepatitis and then were found also to carry HIV, illustrates the poignant struggle of a prudent medical practitioner with inadequate, halfway technologies.

Lovers and Livers is a well-written book, illustrating the ways we construct and change our notions of disease. Duffin's combination of important ideas and accessible prose make...

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