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Oliver Sacks describes himself as a “physician and naturalist,” and as he has written on matters as disparate as ferns, the periodic table, and encephalitis lethargica I am inclined to agree. It is this collection of case reports, however, that I consider to be his finest work.
The book is divided into four thematic parts: “Losses,” “Excesses,” “Transports,” and “The world of the simple.” I discovered it in the sixth form, and it inspired me to study medicine and to practise—like Sacks—in the manner of James Purdon Martin, in which “patient and physician were co-equals . . . learning from and helping the other . . . between them arriving at new insights and treatment.”
Neurology is a fascinating and forbidding subject in equal measure, and the author guides the reader on a path to surreal and “unimaginable lands,” thanks to a combination of mellifluous prose and vivid imagery. Despite the book being more than 22 years old and with some terms that would now be considered pejorative, the stories and their messages remain important.
Sacks ponders on the “privative” language of neurology, how “deficit is its favourite word” and how it struggles when conceptualising an excess, rather than a loss, of function. A parallel can be drawn with the comments of a patient, Rebecca, who believes that doctors focus on the diagnosis and treatment of what is lost, to the detriment of what is retained—a lesson we are yet to learn.
An interesting case is that of Dr P, who has a visual agnosia. We learn how he “pats water hydrants” as if they are children and “addresses carved furniture knobs” yet is surprised at their silence. On leaving the consulting room “he reached out his hand and took hold of his wife’s head, tried to lift it off, to put it on.” This sentence is so alien and fantastic it seems plucked from a work of science fiction. A home visit unearths a beautiful metaphor: we see the progression of Dr P’s pathology charted by his art, as it becomes less “realistic and naturalistic” and more “geometrical and cubist.” Through such visits Dr Sacks delineates both the “I and the It” of his patients, creating a rich narrative.
Another patient, Jimmie G, has Korsakoff’s syndrome. Although 49 years old, he is unable to form or recall memories after his 19th birthday. He views the world with a childlike “innocent wonder,” and we are left wondering whether a “man without a past or future, stuck in a constantly changing, meaningless moment” could be said to have a soul.
This book should be required reading in all undergraduate medical curriculums. It shows that normal and abnormal are not mutually exclusive categories but arbitrary points on a continuum, influenced by their context. It makes us think about our practice and is surely a master class in case reporting. As an aside, it cites James Parkinson as the first practitioner of street medicine (a pastime that surely all doctors indulge in) in the 1800s, long before the BBC popularised it in Street Doctor (BMJ 2007;334:157 doi: 10.1136/bmj.39091.442720.59).
The Man Who Mistook his Wife for a Hat and Other Clinical Tales
By Oliver Sacks
Published in 1985