Wound Ballistics: The Science of Injury and the Mystery of Exploding Bullets

1018Johnkinder-FBToday’s guest post is written by John Kinder, Associate Professor of History and American Studies at Oklahoma State University. He is the author of Paying with Their Bodies: American War and the Problem of the Disabled Veteran (University of Chicago Press, 2015). On Tuesday, October 17, Kinder will give his talk, “A History of American War in Five Bodies.” To read more about this lecture and to register, go HERE.

On March 11, 1944, an American soldier in the 182d Infantry was digging a foxhole on the island of Bougainville when a Japanese bullet ricocheted and hit him in the ankle. The wound didn’t look that serious. There was almost no blood. Still, it was better to be safe than sorry. Medics bandaged the wound, loaded the soldier onto a litter, and started down the hill to the aid station. He was dead before they reached the bottom.

I recently discovered this story in a volume on wound ballistics published by the US Army Medical Department in the early 1960s. Wound ballistics is the study of the physiological trauma produced by modern projectile weapons. It achieved quasi-scientific status in the late nineteenth century, as military physicians and other self-proclaimed wound experts carried out experiments to measure and ultimately predict what happened when chemically-projected metal collided with living human tissue.

Early on, much of their research involved shooting ammunition into pine boards or the carcasses of  animals to estimate the casualty-causing potential of various armaments. Over time, however, wound ballisticians developed increasingly sophisticated techniques for mapping the body’s vulnerability to different weapons and fine-tuning the production of physiological trauma.

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Microsecond X-ray of the femur of a dog after it has been shot by an 8/32-inch steel ball travelling at 4,000 feet per second. The bone has been shattered despite the fact that it was not actually hit by the steel ball. In order to understand the mechanisms of human injury, World War II-era scientists carried out ballistics experiments on a variety of “model” targets including living dogs, cats, pigs, and horses, as well as blocks of gelatin and tanks of water. 

In the process, they also managed to solve one of the most head-scratching mysteries in nineteenth-century military medicine. The mystery emerged in the mid-century, when growing numbers of observers began to notice a peculiar phenomenon: soldiers were dying from what initially appeared to be relatively minor “through-and-through” wounds. High-velocity bullets seemed to enter and exit the body with only minimal damage. Upon autopsy, however, surgeons discovered extensive internal trauma—pulped tissue, ruptured veins, shattered bones—far outside of the track of the bullet. How was this possible? As early as the 1840s, critics charged that the wounds must be the product of “exploding bullets,” which were subsequently banned by international treaty in 1868. In later years, physicians speculated that the internal explosions were caused by compressed air or heat, but nothing could be proven.

Cat

Microsecond X-ray of a thigh of a cat that has been shot by a 4/32-inch steel ball at an impact velocity of 3,000 feet per second. The dark area is the temporary cavity formed as the ball passes through the muscle tissues. X-rays like this one helped wound ballisticians explain the “explosive effect” that mystified nineteenth-century military physicians. 

By the 1940s, scientists were able to use X-rays and high-speed cameras to solve the mystery once and for all. They discovered that, around 200-400 microseconds after a high-speed bullet strikes a human body, a temporary cavity begins to form around the bullet path. This cavity, which expands and contracts in a fraction of a second, can be more than 20 times the volume of the permanent wound track, resulting in the explosive damage to nearby tissue and bone. And, thanks to the elasticity of human skin, the bullet’s entrance and exit wounds might be nearly closed over by the time the patient reaches medical attention. It was remarkable discovery—not least because it affirmed wound ballisticians’ belief that, when it came to understanding injury, the human eye was no match for a scientist and a machine.

To this day, practitioners of wound ballistics like to justify their work in humanitarian terms. The goal of their research, they often say, is to help military surgeons and body armor manufacturers cut down on unnecessary deaths. All of this is true—to a certain extent. From the very start, however, the field of wound ballistics has played a more ominous role in military history. If wound ballistics is the science of injury, it is also the science of injuring others. Understanding the body’s vulnerabilities has allowed warring nations to develop deadlier antipersonnel weapons: armaments designed to pulverize, poison, burn, shred, emulsify, and eviscerate the bodies of one’s enemies.

No doubt, some readers might be wondering about the soldier at Bougainville, the one who died after a light wound to the ankle. Was he too a victim of the “exploding bullet” phenomenon? As it turns out, his death can be chalked up to a more quotidian threat: human error. Today, we can only speculate about the medics’ actions: perhaps they were in a hurry, or perhaps they were exhausted after a brutal day of fighting, or perhaps—and this is my guess—they were so used to seeing war’s butchery that this soldier’s injury appeared inconsequential by comparison. Whatever the reason, they failed to apply a tourniquet to the wounded man’s leg.

Shortly after the litter party started down the hill, the soldier’s ankle began to hemorrhage. As blood drained from his body, he said that he felt cold. Within minutes, he was dead.

References:
1. International Committee of the Red Cross. Wound Ballistics: an Introduction for Health, Legal, Forensic, Military and Law Enforcement Professionals (film). 2008.
2. Kinder, John. Paying with Their Bodies: American War and the Problem of the Disabled Veteran. Chicago: University of Chicago Press, 2015.
3. Saint Petersburg Declaration of 1868 (full title: Declaration Renouncing the Use, in Time of War, of Explosive Projectiles Under 400 Grammes Weight”). November 29-December 11, 1868.
4. United States Army Medical Department. Wound Ballistics. Washington DC: Office of the Surgeon General, Department of the Army, 1962.

Images:
Dog X-ray: Newton Harvey, J. Howard McMillan, Elmer G. Butler, and William O. Puckett, “Mechanism of Wounding,” in United States Army Medical Department, Wound Ballistics (Washington DC: Office of the Surgeon General, Department of the Army, 1962), 204.
Cat X-ray: Ibid, 176.

Open Access to Your State Medical Society Journals

By Robin Naughton, Head of Digital

In 2015, The New York Academy of Medicine Library embarked on a mass digitization project with the Medical Heritage Library (MHL), a digital curation consortium.  Over the course of two years, the Academy Library along with MHL collaborators digitized state society medical journals from 48 states, the District of Columbia and Puerto Rico.  The Academy Library contributed state medical journals from 37 states, which accounted for 716 volumes of the digitized content now available.   Today, you can find, 97 titles, 3,816 volumes and almost 3 million pages of digitized journals on the Internet Archive.

Digitizing the medical journals of state societies has been an amazing experience for the Library and it is a significant contribution to preserving our cultural heritage and making it accessible to anyone with an internet connection.  Researchers and the general public now have access to a major resource on medical history that includes journals from the 19th and the 20th centuries that would not otherwise be available to the public.  “One of the great values of having the state medical journals online is the willingness to provide full-text digital content for materials that would normally be available only with limited content because they are still in copyright,” says Arlene Shaner, Historical Collections Librarian.

Dr. Daniel Goldberg, Associate Professor at University of Colorado, Denver and 2016 Academy Library Helfand Fellow, agrees:

“As an intellectual historian, medical journals in general are really important for my work because they can reveal much about significant ideas and concepts circulating in medical discourse.  I am working on several projects where the specific local and state histories are crucial to the story I am trying to tell, so having full access to digitized state medical journals will be enormously helpful.  I continue to be so grateful for the important work of the MHL and its partners!”

A quick exploration of the journals can be the catalyst for a deeper research project across many disciplines.  For example, what style and design trends can be identified from the covers of the Illinois Medical Journal?

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Illinois Medical Journal through the years.

We invite you to explore the journals, use them, and share with us how they’ve impacted your work: https://archive.org/details/nyamlibrary

Charles Terry Butler and the “War before the War”

By Paul Theerman, Associate Director

The centenary of the United States entry into World War I was this past April. But wars—even those having such sharp cease-fires as this one did, on November 11, 1918—rarely have well-defined beginnings and endings. Even before the official American entry, Americans served in France from the outbreak of the war in 1914. Expats in Paris formed the American Ambulance (the term then meant field hospital), which spun off the American Field Service, charged with transporting wounded soldiers from the front line and providing immediate care. In direct combat, the famed Lafayette Escadrille was founded in 1916, made up of volunteer American air fighters under French command, who battled the Germans up until actual American military deployment two years later. And in the realm of battlefield medicine and surgery, Americans served as volunteers in France from 1914 up to 1917. One of the most noted was Dr. Joseph A. Blake (1864–1937) who, at the outbreak of war, resigned from his prominent surgical positions at Presbyterian Hospital and Columbia College of Physicians and Surgeons, and went to France. There he successively headed up three volunteer hospitals in Neuilly, Ris-Orangis, and Paris, up until his induction to the American military medical corps in August 1917 where he continued his work.

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“Merry Christmas to J.A.B” [Joseph A. Blake, chief surgeon and hospital director], December 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Blake had an outstanding reputation, so much so that he readily attracted both funds and workers. One such surgeon was Charles Terry Butler (1889–1980) whose memoir, A Civilian in Uniform (1975), and personal papers are held in the Academy Library. Butler was born in Yonkers, New York, to a prominent family. He was the son of lawyer William Allen Butler, Jr., whose father, William Allen Butler, Sr., both lawyer and author, was himself the son of Benjamin Franklin Butler, U.S. attorney general in the Andrew Jackson and Martin Van Buren administrations. Charles Butler led a life among the New York elite. As one example, he remembers that his family hosted William Howard Taft to dinner during his presidency.[1] Butler went to Princeton University, where he graduated in 1912, and then to medical school at Columbia University College of Physicians and Surgeons. After his graduation in 1916, he was due to take up an internship at Presbyterian Hospital that July. He postponed it to January in order to serve under Blake, then at the Anglo-French volunteer hospital in Ris-Orangis, France, some 25 miles southeast of Paris. As Butler put it:

My two year internship would be put off six months, but here was the opportunity to learn the treatment of serious war wounds under a great surgeon, perhaps my only chance to have such training, and if the United States were forced into the war, I would be much more useful to the Army.[2]

Blake promised Butler scant remuneration, 400 francs travel expenses each way, and 100 francs a month salary, relying on his “contribution” to aid the cause.[3]

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Charles Terry Butler identity card for Ris-Orangis hospital, June 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Butler left for Liverpool on May 27, and—after a long period of negotiating his credentials to enter France, as authorities were concerned about German infiltrators—he arrived at the Ris-Orangis hospital on June 10. A converted college, long empty before its refitting, the hospital was organized by two English patrons and operated by private donations and support from the French military. The hospital held about 200 beds, with a surgical theater and supporting radiology and bacteriological facilities, as well as, of course, kitchens and laundries.

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Charles Terry Butler dressing a wound with the aid of two nurses, 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

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A recovery ward, 1916. The flags of Britain and France are mounted at the window, as this hospital was a joint effort: operated within the French military hospital system, sponsored by private British philanthropy, and staffed by American surgeons. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Butler’s letters home trace his awakening to war and medicine. Within a week, he wrote to his uncle Clare:

The hospital has about 200 beds, and on my arrival I was put in charge of two wards with over 90 beds and some 80-odd patients. It was some contract to start with, and for two or three days I hardly knew whether I was coming or going. I did about forty dressings a morning with three nurses to help me, and two getting their patients ready for dressing ahead of me and bandaging up when I was through. It took over three hours of hard, steady work.[4]

After a month, to his mother:

Last Sunday, 65 new blessés arrive—the majority of them frightfully wounded. They come by ambulance from a distributing railroad station some 6–7 kilometers away. Arriving in bunches of four or eight, they are sent immediately to their beds. Most of the orderlies had been given leave that day, so we doctors had to turn to and help carry them to the wards. (It isn’t particularly easy carrying a large man on a heavy stretcher with his trappings up three flights of stairs.) There they are undressed; their clothes put in a bag, tagged, and sent to be sterilized and cleaned; and then bathed. . . . The next thing is food. Many have not had anything for 24 hours or more while en route from the front or the last hospital. Then the surgeon comes along. Dressings, casts, splints, etc. are removed so as to see the condition and nature of the injury. It would be impossible to describe the state of some of the wounds—many not having been dressed for several days, some even for 10 or 14 days. A hasty and rather superficial cleansing must suffice for the time being, until the patient comes back from the X-ray room. … All the wounds are terribly infected, and a large percentage have foreign bodies (balls, pieces of shell, clothing, stones, dirt, etc., etc.) lodged…. [Surgery followed, aided by X-ray and fluoroscopy.] The recoveries are wonderful. Men whom no one would expect to live, ordinarily, in a civil hospital, hang by a hair for days and come around O.K.[5]

Butler noted that the average length of stay at the hospital was almost 50 days.

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The staff of the Ris-Orangis Hospital, 1916. Dr. Joseph A. Blake, director, is the central figure (second row, seated); Charles Terry Butler is the third man to his left. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Ris-Orangis was considered one of the most successful hospitals in the war. [One of the founders, Harold J. Reckitt, wrote a detailed history of the hospital, V.R. 76: A French Military Hospital (1921)]. Butler spent most of his time dressing wounds, with little occasion for actual surgery. He returned to New York in January 1917 to take up his internship at Presbyterian. But upon the American entry into the war in April 1917, he was commissioned a first lieutenant with the United States Medical Corps, serving into 1919—the topic of a future blogpost. Butler’s experience at Ris-Orangis was crucial to his surgical accomplishments in this second phase of war service. After the war, he entered private practice, but by 1923 ill health—apparently resulting from wartime conditions—led Butler to retire. Moving to the Ojai Valley of Ventura County, California, he became a prominent civic and cultural leader up to his death in 1980.

References:
[1] Butler, Charles Terry. A Civilian in Uniform. Butler, 1975, p. 28.
[2] A Civilian in Uniform, p. 49.
[3] Blake to Butler, 29 April 1916, A Civilian in Uniform, p. 49.
[4] Butler to “Uncle Clare” [Clarence Lyman Collins (1848–1922)], 17 June 1916, A Civilian in Uniform, p. 57.
[5] Butler to “mother” [Louise Terry Collins (1855–1922)], 7 July 1916, A Civilian in Uniform, p. 62–64.

Images:
Charles Terry Butler, “Ris-Orangis, France, 1916,” photographic album. Charles Terry Butler papers. New York Academy of Medicine Library.

The Language of Textiles and Medicine

Today’s guest post is written by Kriota Willberg, New York Academy of Medicine’s Artist-in-Residence researching the history of sutures and ligatures.  Through graphic narratives, teaching, and needlework, Kriota explores the intersection between body sciences and creative practice. Starting this week, Kriota will be teaching a four-week workshop entitled “Embroidering Medicine,” which explores relationships between medicine, needlework, and gender. There is still time to register for this workshop, which begins September 14.

As an artist working with textiles and comics (two media often considered domestic or for children), I am interested in the interplay of culturally common materials, tools, and language with those of professional specialty. From the research I have done on the history of sutures and ligature, it appears that the staples of domestic needlework: thread/sinew, cloth/hide, scissors, pins, and needles have been appropriated from domestic use since the time of their invention, to assist in the repair of the body. Similarly, the language of domestic and professional needlework has been re-purposed to describe closing wounds.

Many of the texts I am reading describe the characteristics and purposes of various surgical needles, the type of textiles used for bandaging (linen, wool, cotton), and the type of thread used for various types of sutures (linen, silk, cotton, catgut). I have also found descriptions of wool and flax production by Pliny the Elder in the first century AD, an account of French silk production in 1766 from John Locke, and a couple 20th-century books detailing the history of catgut.

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Ligatures and Sutures by Bauer and Black (c1924) chapter on “Preparation of Bauer & Black Catgut.”

Although I don’t know when a physician’s sewing kit diverged from those of a seamstress or leather worker’s sewing kit, John Stewart Milne writes in his book Surgical Instruments in Greek and Roman Times:

“Three-cornered surgical needles were in use from very early times. They are fully described in the Vedas of the Hindoos… A few three-cornered needles of Roman origin have been found, although they are rare.”[1]

In addition to describing the specific uses of surgical needles, Milne also discusses the uses of domestic needles in stitching bandages by Roman physicians.[2]

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A collection of needles and probes. Source: Surgical Instruments in Greek and Roman Times (1907) by John Stewart Milne.

Galen reinforces this play between textiles, medicine, and the body by describing damage to the body through the metaphor of fabric:

“It is not the job of one art to replace one thread that has come loose, and of another to replace three or four, or for that matter five hundred… In quite general terms, the manner by which each existent object came about in the first place is also the manner in which it is to be restored when damaged.

The woof is woven into the warp to make a shirt. Now, is it possible for that shirt to sustain damage, or for that damage to be repaired, in some way which does not involve those two elements? If there is damage of any kind at all, it cannot but be damage to the warp, or to the woof, or to both together; and, similarly, there is only one method of repair, an inter-weaving of woof and warp which mimics the original process of creation.”[3]

The tandem development of textile production and medicine becomes part of the domestic-to-medical interface of textiles and their tools manifested through the language used to describe materials, tools, and stitches.

In his Major Surgery (1363), in a chapter about “sewing” wounds, Guy de Chauliac describes wrapping thread around a needle in the same method that women use to keep threaded needles on their sleeves. He also describes using hooks to bind wounds. This closure technique is attributed to wool cutters or (wool) walkers.[4] Later Ambrose Paré, paraphrasing Guy’s description of another type of suture says, “The second Suture is made just after the same manner as the Skinners sow their…furs.”[5] Paré also uses the keeping a needle on one’s sleeve description when describing surgical repair of harelip (known today as cleft lip).

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Bottom illustration showing an example of thread winding described by Paré and Guy de Chauliac. Source: The Workes of that famous Chirurgion Ambrose Parey (1634).

The language of needlework and textiles is used to educate and inform the student surgeon about the body, health, and suturing techniques.  Woof and warp, wrapping needles, closing a wound as a wool walker would fasten wool, and suturing the body with the same stitch used by a Skinner, seem to be descriptions one is expected to understand and mimic. What is a wool walker? Thanks to Wikipedia I can tell you that “walking” is a step in cloth making, also called fulling, in which one pounds woolen cloth with one’s feet to thicken and clean it.[6] I still haven’t figured out how they fasten the wool with hooks.

References:
[1] Milne, John Stewart. Surgical Instruments in Greek and Roman Times. Oxford: Clarendon Press, 1907, p.75.
[2] Milne. p.75-76.
[3] Galen. Galen : selected works ; translated with an introduction and notes by P.N. Singer. Trans. Peter N. Singer. Oxford: Oxford University Press, 1997.
[4] Guy, de Chauliac. The cyrurgie of Guy de Chauliac. Ed. Margaret S. Ogden. London, New York: Early English Text Society by the Oxford Univ. Press, 1971, p.192.
[5] Paré, Ambrose. The Workes of that famous Chirurgion Ambrose Parey Translated out of Latine and compared with the French. Trans. Th: Johnson. London: Th:Cotes and R. Young, 1634, p.327.
[7] Wikipedia. Fulling. 10 July 2017.

How to Become a Doctor (in 1949)

By Allison Piazza, Reference Services and Outreach Librarian

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How to Become a Doctor (1949) by George R. Moon.

While shelving books, I had the great pleasure of discovering a small book entitled How to Become a Doctor. Published in 1949, How to Become a Doctor is, at just 131 pages, “a complete guide to the study of medicine, dentistry, pharmacy, veterinary medicine, occupational therapy, chiropody and foot surgery, optometry, hospital administration, medical illustration, and the sciences.”

The author of the book, George R. Moon, was the Examiner and Recorder at University of Illinois Colleges of Medicine, Dentistry and Pharmacy.  As for Mr. Moon’s qualifications, the writer of the forward states: “it is probable that no one person in the world has met more students seeking advice regarding entrance to schools of medicine, dentistry and pharmacy.”

As intended, I learned quite a bit about the medical school admissions process while reading this guide. I was surprised to learn that, in 1949, not many medical schools required a bachelor’s degree for admission, with only 4 schools requiring the degree, 58 asking for three college years, and 7 indicating they would consider 2 years of college work.  This is basically unheard of today in the U.S.

Medical School by the numbers: 1948-1949 and 2016-2017

1948-1949 2016-2017
Approved U.S. 4-year medical schools 71 147
Applicants At least 20,000 53,042 [1]
Application fee $5-$10 per school $160 first school; $38 per additional school [2]
Enrollment 6,559 21,0301 [1]
Tuition at Harvard Medical School $830* $58,050 [3]
Female matriculates 11% (1947) 49.8% [1]
Medical school graduates 5,543 18,938 [4]

*The highest annual fee at any medical school in 1948-1949.

Further into the guide, Mr. Moon discusses the application process, offering a sample application from the University of Illinois.  One question from this four page application is: How and where do you spend your summer vacations?

After the application comes the interview.  Mr. Moon’s primary advice is on appearance, stating that “this is one place where the typical ‘Joe College’ attitude should be forgotten.” He goes on to say that the student should act natural and answer questions directly and fully but “avoid anything fancy.”

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Chapter images from How to Become a Doctor.

To conclude, just who was the ideal medical school applicant in 1949? Mr. Moon offers the following description:

“The ideal will, of course, have superior college grades, a broad, balanced liberal arts program, be not over 22 years of age, have high moral standards and professional ideals, be reasonably attractive personally, be poised and at ease in his interviews, speak clearly and correctly, be clean and fastidious as to dress and appearance, and have enough financial backing so that he will not be forced to work or be worried by money matters, and last but not least, be physically strong and healthy.”

References:
[1] “U.S. Medical School Applications and Matriculates by School, State of Legal Residence, and Sex, 2016-2017.” Association of American Medical Colleges, December 6, 2016.
[2] “Applying to Medical School.” Association of American Medical Colleges, n.d.
[3] “Tuition and Fees.” Harvard Medical School, November 29, 2016.
[4] “Total Graduates by U.S. Medical School and Sex, 2011-2012 through 2015-2016.” Association of American Medical Colleges, December 19, 2016.

Sample Medical College Admission Test (MCAT) questions from How to Become a Doctor:

Vocabulary:

1. AUDACIOUS: (A) splendid (B) loquacious (C) cautious (D) auspicious (E) presumptuous

Quantitative Ability:

2. It is known that every circle has an equation of the form Ax2 + Ay2 + Bx + Cy + D = 0. Which of the following is the equation of a circle?
A) 2x – 3y = 6
B) x2 – y2 + 4x – 2y + 3 = 0
C) 3x2 + 3y2 – 2x + 6y +1 = 0
D) 2x2 + 3y2 + 6x + 4y +1 = 0
E) None of the above

Understanding of Modern Society:

3. Japan today presents no immediate threat to peace in the Far East principally because:
(A) so much of the country has been devastated
(B) she has been stripped of her colonies and conquests
(C) the present Japanese constitution outlaws war
(D) the new Japanese government is much opposed to the military party
(E)there is now unity of purpose among the various interest in the Far East

Premedical Sciences:

4. Which one of the following is 75 percent carbon, by weight, and 25 percent hydrogen, by weight?
(A) 
C3H
(B) 
CH
(C) 
CH3
(D) C2H3
(E) CH4

Answers: 1. (E), 2. (C), 3. (B), 4. (E)

Eyes Turned Skywards

By Anne Garner, Curator, Rare Books and Manuscripts

Ain’t no sunshine when she’s gone….as the song goes, or, on a day like today, when the moon encroaches on the sun. With all eyes turned skywards, we’re taking the long view on star-gazing, looking back to many of our great sixteenth-century astronomy books for inspiration.  Last week, in honor of today’s solar eclipse, we hosted Atlas Obscura in our rare book room for a ticketed event highlighting some of our favorite images of the stars, planets and astronomers– those inquisitive heavenly creatures who made great strides in changing what we know about the physical universe.

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A pocket-sized French book, Les fleurs et secrets de medicine, published around the turn of the 16th-century, offers this partially covered sun, in the image on the left.  On the right, from the same book, our hero, the astronomer.

After Homer’s Iliad and Odyssey, the most popular poem produced by the ancient Greeks was Aratus’ Phaenomena.  Aratus, born in Soli in Cilicia, lived in the late fourth and early third centuries B.C.E.  As a young man, he studied Stoic philosophy in Athens at the school founded by Zeno. Building on a tradition of didactic poetry exemplified by the epic poet Hesiod, the Phaenomena, Aratus’ only complete extant work, explained the constellations and the effects of the planets and stars on human event in verse. A Latin translation of the poem appears in our 1499 Astronomicae Veteres, a compilation of early astronomy texts printed by Aldus Manutius in Venice.  Many of the woodcut images of constellations accompanying the poem date to an earlier Venetian publication of Hyginus’ star atlas, printed by Erhard Ratholdt.

The image of the Pleiades in the illustrated Aratus can likely be attributed to the artist of the famous Hypnerotomachia Poliphili also published by Aldus Manutius in the same year.

The Academy Library has five copies of the Fasciculus Medicinae –a compilation of medical treatises, many from the medieval period first published in 1491 (our earliest edition dates to 1495).  This compiler was probably an Austrian physician named Kircheim, which the Italian publishers corrupted to Ketham.  Kircheim, born in Germany, was professor of medicine in Vienna in about 1460.

The Fasciculus Medicinae contains the earliest realistic anatomical images in print.  The book’s astonishing woodcut illustrations include skilled renderings of medieval prototypes including this one of Zodiac Man, below.  The woodcut offers a visual demonstration of the belief that the planets and stars governed the openings of the body.  The accompanying text advised when bloodletting could be safely done to treat different parts of the body, depending on the dominant sign. A variation of Zodiac Man continues to feature in astrological publications through the early twentieth-century, as a staple feature of the English and American almanac.

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Ketham’s Zodiac Man (1522).

The sixteenth-century Spanish physician and surgeon Andrés de León includes this excellent Zodiac Man (below) in his 1590 De Annatomia.

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de Leon’s Zodiac Man (1590).

The German monk Gregor Reisch is responsible for the astonishing Margarita Philosophica (Philosophical Pearl), first published in 1503. This early general encyclopedia purported to gather together all of the general knowledge considered mandatory for any real Renaissance man. The Margarita was used as a general textbook both for private study and in universities throughout Western Europe.  Our 1517 copy, published in Basil, includes arresting woodcut images, including a scene of Astronomia aiding Ptolemy in his sky-watching ventures, a Ptolemaic armillary sphere, and an image of celestial phenomena.

Images from the Margarita (1517): Astronomia aiding Ptolemy (left), Geocentric World (center), Meteora (right).

It also includes this timely woodcut (below), illustrating the various positions of the Earth, the Sun and the Moon when eclipses occur.

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From Reisch’s Margarita (1517): Eclipse, 1517.

The Dalmatian author Federico Grisogono’s Pronostica offers readers a working volvelle (below) which could be used to predict the critical days of solar and lunar fevers. Attentive and star-savvy caregivers might be able to determine optimal treatment for their patients using Grisogono’s movable diagnostic tool (but don’t ask us to forecast the day your fever will lift, it’s complicated!).

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Grisogono’s volvelle (1528).

Finally, we’d be remiss if we didn’t include the astronomy publication that causes the big(gest) bang of the century. In 1543, Mikolaj Kopernik (better known to us by his Latin name Nicholas Copernicus) published his watershed De revolutionibus orbium coelestium libri sex, or six books on the revolution of the heavenly spheres, shortly before his death. The book recorded Copernicus’ assertion that the planets revolve around the Sun, and not the Earth.  Copernicus’ ideas are taken by two later Renaissance astronomers who solidify his work. Tycho Brahe uses his heliocentric assertion to collect observations of the sun. Johannes Kepler does the heavy-lifting in terms of calculations, applying Tycho Brahe’s data to Copernicus’ heliocentric assertions and working them out mathematically.

Copernicus’ work created aftershocks for scientific observers attempting to map the physical universe, similar to those produced by Andreas Vesalius when he published his landmark De fabrica humani corporis (thus altering the anatomical map of the body) that same year.  Our edition of De revolutionibus is the second, from 1566.

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Image of concentric circles. Copernicus’ De Revolutionibus (1566).

Incidentally, you can consult another famous astronomer’s work, Cardano’s Libelli quinque, to see this nativity, or astrological chart for Andreas Vesalius’ life (as well as charts for other Renaissance celebrities like Albrecht Durer, Martin Luther, and a Medici or two).

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Cardano’s Vesalian chart (1547).

You’ll find the two remaining ticketed Atlas Obscura events for 2017 listed here and here.

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Thanks to attendee Jasmine for this great pic!

Just my Optotype

By Emily Miranker, Events & Projects Manager

You’ve probably seen the star of today’s post. Or, rather, peered at it trying to see it clearly (like yours truly). That pyramid of big letters with subsequent lines of more letters getting smaller and smaller: the eye chart.

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The relationship of the distance at which the test is done and the distance as which the smallest figure is (correctly) identifiable defines the patient’s visual acuity. Source: John Weiss & Son (1898).

The German physician Heinrich Kuchler created the first eye chart in 1836 with cuttings from books, papers, and almanacs that he glued to a sheet in ever decreasing size.

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Kuchler eye chart. Source: SchoolHealth.com

While Kuchler’s example above is not as cleanly designed as this post’s first image, it was a definite improvement over times past. People basically had to self-diagnose themselves or read a piece of text with a doctor and pick the (hopefully) correct lenses. By the nineteenth century, the need for individualized lenses was clear. In 1862 Dr. Franciscus Donders asked his colleague (and eventual successor to the directorship of the Netherlands Hospital for Eye Patients), ophthalmologist Herman Snellen to design a chart.[1] Now called the Snellen chart, it has become one of the most common.

According to Smith-Ketterwell Eye Research Institute scientist and an eye chart design expert, Dr. August Colenbrander, Snellen experimented with dingbats, shapes and even lines of text for the eye chart.[2] But patients could assume the ending of phrases based on context, and symbols were hard to describe. So Snellen stuck to letter forms –but do they look a little odd to you?

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To the right of the above Snellen Chart is an E Chart, sometimes called a Tumbling E Chart, which works along the same principles but is used for those who cannot read, like children, or patients unfamiliar with the Latin alphabet. Source: Reynders, John, & Co. (1889)

If your answer is yes, you’re picking up on the fact that Snellen developed a specific kind of letterform called an optotype. Once he concluded that letters were better for vision, he speculated that subjects would identify equally weighted letters of consistent size more easily. So he created a complete typeface in a grid system.

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Optotype on 5×5 grid. Source: http://abcdefridays.blogspot.com

Typical typefaces have different line thicknesses and ornamental touches (like the dot on lowercase i’s, the cross-stroke of T’s).  Letter proportionality is usually determined by family groupings (like h, m, n, r, and u). Snellen developed a 5 x 5 grid for his optotypes so the width and height of an optotype is five times the thickness of the line weight.[3] Snellen based his grid on a medical measurement, the arcminute, or one sixtieth of a degree.[4] In optotypes, the weight of a line is equal to the negative space between lines. Typically, C and D would appear wider than Z. The opposite is true of optotypes.

Snellen isn’t the only game in eye chart town. Others include the Jaeger chart, Landolt C, LEA test, LogMAR charts and the Golovin-Sivtsev table. Retired eye surgeon and antique eye glasses expert David Fleishman attributes the Snellen’s widespread popularity even after the advent of other vision assessments to it’s being a “low-tech solution to a complex problem because it was cheap and easy to use.”[5] The 21st century is making its own easy to use -if high-tech solutions– such as the newly released Warby Parker Prescription Check app which utilizes a user’s laptop and iphone to check their vision. The app allows an eye doctor to assess your prescription; though the app stresses it does not replace a comprehensive eye exam.

Warby Parker app

Warby Parker website.

Whatever computer screens hold for the future of vision checks, the Snellen remains one of the top selling posters in the United States.[6]

Special thanks to Avery Trufelman and the 99 Percent Invisible podcast team for inspiration from Episode 242: Mini-Stories: Volume 2.

References:
[1] Kennedy, Pagan. “Who Made that Eye Chart?” The New York Times. New York: May 14, 2013.
[2] Frear, Lori. “What are Optotypes? Eye Charts in Focus,” I Love Typography: July 12, 2015. Accessed 8/1/17.
[3] Frear, Lori. “Examining the Fascinating Typographic History of Eye Charts.” Gizmodo: September 24, 2015. Accessed 8/2/17.
[4] Kalatschinow, Alex. “Optotype: Typography of the Eye Chart,” ABCDEFridays: A Typographic Inspiration Blog: Tyler School of Art of Temple University. Accessed 8/2/17.
[5] Kennedy.
[6] Bordsen, John. “Eye Chart Still the Standard for Vision.” Seattle Times. Seattle: August 9, 1995.
Eye chart blog shop ad

“The Politics of Infrastructure” Class Review

By Audrey Sage Lorberfeld, Digital Technical Specialist

As part of the ongoing collaboration between the Brooklyn Institute for Social Research (BISR) and The New York Academy of Medicine Library, I was able to spend the beginning of summer contemplating how material and immaterial infrastructures affect peoples’ daily lives.

Throughout the BISR course titled “The Politics of Infrastructure,” taught by one of my favorite professors, Danya Glabau, we covered everything from why park benches are a certain length (so that people don’t sleep on them), to the United States’ unique economy of technological obsolescence. We took some deep dives into theoretical texts, such as Michelle Murphy’s Sick Building Syndrome and the Problem of Uncertainty and Bruno Latour’s Science in Action: How to Follow Scientists and Engineers Through Society. We were also encouraged to apply what we read to our daily lives. During my morning commutes, I suddenly found myself wondering if an umbrella or a subway car were inherently political objects (and what this might mean for their construction and use).

As always, there were beautiful treasures from the Academy Library that we were able to view during class, thanks to our Rare Books and Manuscripts Curator Anne Garner’s expansive knowledge of our holdings. One item she found for the class that was particularly striking was Stephen Smith’s The City That Was (1911).[1] We used this item as a complement to our unit titled “Infrastructure and Public Health,” where we read critical texts such as Paul Farmer’s “An Anthropology of Structural Violence” and Manjari Mahajan’s “Designing Epidemics: Models, Policy-Making, and Global Foreknowledge in India’s AIDS Epidemic.”

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Image from Smith’s The City That Was (1911) showing the “Region of Bone-Boiling and Swill-Milk Nuisances.”

Smith was a New Yorker who many now regard as the father of public health. He founded the American Public Health Association and was the first to attribute the spread of typhus and cholera to environmental conditions around New York City.[2] Without him, New York would likely not have advanced into the public health-conscious city it is today (at least not as quickly). In The City That Was, Smith outlines through detailed illustrations various areas of the city that were public health concerns. I hate to imagine what Nolita’s trendy residents would think of their apartments if they knew they were once next to noxious hide-curing and fat-gathering houses.

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Image from Smith’s The City That Was (1911) showing the “Region of Hide-Curing, Fat-Gathering, Fat and Soap Boiling, and Slaughter-Pens, Behind the Bowery Shopping Houses.”

While examining physical infrastructures, past and present, provided us with the tools to critique New York’s metropolitan landscape responsibly, we also learned about more cerebral types of infrastructure. One author whose work particularly struck me was Susan Leigh Star. In her article titled “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” she examines the power of living in between worlds, and challenges her readers to question the idea of standardization. Of the latter, she brings attention to stoplights, writing: “The initial choice of red as a colour of traffic lights that means, ‘stop’, for example, is now a widespread convention that would be functionally impossible to change, yet it was initially arbitrary.” And it’s true — who decided that red meant stop? Why does red mean stop everywhere now, from stop signs to walk signals?

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Diagram showing Star’s theory of the dimensions of power, from “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” 1991.

For me, the power of Star’s scholarship really became solidified throughout her discussion of marginality, though. She writes:

“We are at once heterogeneous, split apart, multiple — and through living in multiple worlds without delegation, we have experience of a self unified only through action, work and the patchwork of collection biography . . . That is, in the case of Pasteur or any executive, much of the work is attributed back to the central figure, erasing the work of secretaries, wives, laboratory technicians, and all sorts of associates. When this invisible work . . . is recovered, a very different network is discovered as well . . . All of these ways of gaining access imply listening, rather than talking on behalf of. This often means refusing translation — resting uncomfortably but content with that which is wild to us.”[3]

As someone who works in the intersection of medicine and the social sciences, the ideas in the above quote seem especially relevant. Biological scientists hate lingering in the unknown, while social scientists get tenure by writing about it. The idea of a library whose collections reflect the chameleonic history of medicine likely exists in a space much like Star’s “multiple worlds.” And, similar to those lab technicians whose names you never read about when a team of scientists win the Nobel Prize, libraries function largely on invisible labor. Thanks to Star, I am getting more comfortable with my own brand of marginality, too.

Glabau lead us expertly down these paths and many more during my time as a BISR student in “The Politics of Infrastructure.” We are currently hosting another one of her classes (“Science, Race, and Colonialism“), so stay tuned for more synopses from the field.

References:
[1] Smith S, The City That Was. New York, NY: F. Allaben; 1911.
[2] A Short Narrative of Dr. Stephen Smith. Medph.org. Published 2016. Accessed July 10, 2017.
[3] Star S. Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions. The Sociological Review. 1991; 38(S1):26-55, p29-30.

The Other Language of Flowers: The Doctrine of Signatures

By Emily Miranker, Events & Projects Manager

“Is that page winking at me?”

I said this at the office last week, and it’s actually not the weirdest of the sentences I’ve uttered at work here at the library. Some of those include, “That’s the prettiest hairball I’ve ever seen!” and “Yeah, I do wish garlic cured the plague.”

In this case, the sixteenthcentury page in question was winking at me (in a manner of speaking). Page 135 of our 1588 edition of Neapolitan natural scientist and polymath Giambattista della Porta’s Phytognomonica features a woodcut of eyebright. Eyebright is an alpine plant that gets its name for its use treating eye ailments.

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As this woodcut aims to make very clear with the frontal and side views on the bottom of the page, the fully open flower resembles a human eye. Image source: Giambattista della Porta, Phytognomonica (1588).

The resemblance of a plant to the body part or malady that it cures is a concept called the Doctrine of Signatures. Along with other early classical scholars, Roman natural philosopher Pliny the Elder and the Greek physician Dioscorides make reference to the Doctrine, but it was best developed by medieval Swiss physician and alchemist Paracelsus (1493-1591).[1] The Doctrine was widely believed in the West, especially in the sixteenth and seventeenth centuries, though it did persist beyond.[2] Nineteenth century American historian and novelist Edward Eggleston observed, “The wild woods were full of creatures (flora and fauna) whose value was written on each of them in the language of signatures … considerately tagged at the creation.”[3] I love this notion, not for its accuracy–it is not accurate, definitely do not eat a plant with heart-shaped leaves if you have heartburn–but because I think it’s a terrific design concept. Simply put, function dictates form and outward appearance reveals therapeutic value.

I’m not alone in affection for the “much-maligned” theory that biologist Bradley C. Bennett called “the Doctrine.” He argues that in many preliterate societies, the association of plant name with its medicinal uses helped people remember useful plants.[4] Similarly, anthropologist G. H. Shepard Jr. suggested such names or signatures are like a mnemonic device for peoples for whom knowledge transmission is oral.[5] Of course, the Doctrine had detractors. Flemish herbalist Rembert Dodoens declared it “absolutely unworthy of acceptance” in 1583.[6] It is inherently subjective (not a good thing for science)–a leaf that looks like a liver to me might look like a kidney to you.

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Hair loss an issue? Maidenhair fern to the rescue. Image source: Giambattista della Porta, Phytognomonica (1588).

Signatures as a method to remember plants makes sense, particularly with all the scientific advances debunking the medical rationale since della Porta published his book. Bennett conducted an experiment that underscores the memory aid value of the Doctrine “that many valuable herbs were in use before the doctrine and that the organ-plant match was made later to accommodate and validate the doctrine.”[7] Of the over 2,500 plants with heart-shaped leaves, Bennett randomly selected 80. Twenty-one of those were used in medicine, and only three were used in cardiac medicine. So much for every ‘signed’ plant having therapeutic value.

So more accurately, the Doctrine of Signatures is a very human design concept. Indeed, it’s a human-centric design concept; seeing bits of ourselves in bits of plants. This makes sense when you consider that in della Porta’s time it was assumed the universe was created (by God) with mankind at the mortal pinnacle. And remarkably effective, not as a medical truism, but as a memory device.

For what is good design but a simple and powerful solution to a problem, in this case how to remember helpful plants. Not only is 20 percent of our brain devoted to vision, but there is a specific area in the frontal lobe of the brain critical to facial recognition: the fusiform gyrus. “We are hardwired to seek out a round object with two dark bands (one for the eyes, one for the mouth) even before we can see them clearly,” observes neuroscientist Andrew Tate.[8] Is it any wonder that people saw faces (not to mention other body parts) in the plants around them?

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Plants resembling the human hand and teeth. Image source: Giambattista della Porta, Phytognomonica (1588).

References:
[1] Bennett, Bradley C. “Doctrine of Signatures Through Two Millennia,” HerbalGram No. 78 (May-July 2008): 34-45.
[2] Simon, Matt. Fantastically Wrong: The Strange History of Using Organ-Shaped Plants to Treat Disease, Wired. Accessed 7/24/17.
[3] Eggleston, E. The Transit of Civilization from England to America in the Seventeenth Century. Appleton and Company: New York, 1901.
[4] Bennett, Bradley C. “Doctrine of Signatures: An Explanation of Medicinal Plant Discovery or Dissemination of Knowledge?” Economic Botany 61 (3). New York: The New York Botanical Garden Press, 2007: 246.
[5] Shepard, G.H. “Nature’s Madison Avenue: Sensory Cues as Mnemonic Devices in the Transmission of Medicinal Plant Knowledge,” Ethnobiology and Biocultural Diversity: Proceedings of the 7th International Congress of Ethnobiology. University of Georgia Press: Athens, GA, 2002: 326-335. Accessed 7/25/17.
[6] Arber, Agnes Robertson. Herbals, their origin and evolution; a chapter in the history of botany, 1470-1670. Cambridge: The University press, 1938
[7] Bennett, p 250.
[8] Tate, Andrew. “10 Scientific Reasons People are Hardwired to Respond to Your Visual Marketing,” Canva. Accessed 7/26/17.

A Brief History of the Vampire

By Audrey Sage Lorberfeld, Digital Technical Specialist

Most people associate vampires with Bram Stoker’s Count Dracula; however, the vampire has much older roots than that. Robert McCully reports that “the earliest known depiction of a vampire appears on a prehistoric Assyrian bowl…”[1] Much later came the vampiric texts with which we in the West are familiar, like Samuel Taylor Coleridge’s Christobel (1797), Marquis de Sade’s Justine (1791), and John Keats’s Lamia (1819).[2] Finally, in 1897, comes Stoker’s Dracula.

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Chapter heading illustration, from Paul Barber’s Vampires Burial and Death: Folklore and Reality, 1988.

Perhaps the easiest place to start a history of the vampire is the differentiation between the folkloric vampire and the fictional vampire.

The Folkloric Vampire

Paul Barber warns that “if a typical vampire of folklore…were to come to your house this Halloween, you might open the door to encounter a plump Slavic fellow with long fingernails and a stubby beard, his mouth and left eye open, his face ruddy and swollen… [his] nose fallen in somewhat, the hair, beard, and nails grown, and new skin formed under the old” (a lovely phenomenon called ‘skin slippage’).[3] Other telltale signs of folkloric vamps are that people usually kill them with stakes (the act of which causes them to bleed and emanate ‘painful’ sounds); they like to attack cattle; they can regenerate;[4] and they bite.[5]

Regarding the origins of the folkloric vamp, Barber puts forth a forensic and socio-political argument. In short, Barber thinks that the idea of the folkloric vampire arose from the exhumation of decomposing bodies. These bodies normally have a little blood at their mouths, they get bloated, they smell, and they bleed when cut.[6] Barber believes that these bodies were likely scapegoats for society’s fears of plague or murder victims, whose bodies were buried in shallow graves (meaning that they decomposed faster).[7] When these ‘vampires’ were exhumed for inspection (which happened when a corpse was accused of being a vampire) and were ‘killed’ with stakes, it would be normal for a decomposing body to lack rigor mortis and also let out a painful sound, like the one mentioned previously. In reality, this sound is just the bloated body expelling methane.[8]

The Fictional Vampire

The fictional vamp, on the other hand, is the pop culture phenomenon. These vampires are “power mad” and want “nothing less than to take over the world, with the aid of an army of subordinate vampires.”[9]

This fictional vamp is the creature to which the real-life disease porphyria can be (dubiously) linked. Porphyria is a term given to multiple diseases that involve “enzyme defects in the haem biosynthetic pathway.”[10] Coming from the Greek word πορφύρα (pronounced “por-FOO-ra”), meaning purple, porphyria sufferers usually have red- or purple-tinged urine. This discoloration is caused by an excess of porphyrins.[11] Porphyrins are “light-activated chemicals that can be used to combat ills including tumors and diseases of the eye.”[12] Porphyria is also the disease many think plagued King George III.[13]

The specific type of porphyria most link to vampires is congenital erythropoietic porphyria (CEP), otherwise known as Gunther’s Disease.[14] Roderick McEwin writes that “this extremely rare disease presents on first exposure to light . . . blistering [the] exposed skin,” and that the urine, teeth, and bones, all stained pink, fluoresce in ultraviolet light.[15] These symptoms would explain why we usually associate vampires with burning in the sun.

Regarding the blood-sucking behavior of typical (fictional) vampires, Lane writes that it is possible early scientists linked vampires to porphyria patients because, in principle, it is possible to relieve the symptoms of porphyria by drinking blood. Not all scholars buy this argument, however. Maranda et al argue that there is no “scientific explanation for why people with porphyria would benefit from drinking blood” and that true porphyria patients suffer from scarring, which does not complement the world’s perception of (fictional) vampires.[16]

Another belief is that vampires arose from real people getting rabies. Juan Gómez-Alonso writes about how rabies sometimes presents in spasms and the emission of hoarse sounds that together make someone’s teeth clench and lips retract like those of an animal. The spasms are “generally triggered by some stimuli,” which include light (“photophobia”). Rabies might also explain vampires’ relationships to mirrors. Gómez-Alonso tells us that “a man was not considered rabid if he was able to stand the sight of his own image in a mirror.”[17]

There is almost too much that could be said about the vampire’s history. The vampire has been around for a long time, and continues to be a source of fascination. In fact, the next time you are on the 6 train, just look up and check out the ad for Casper® mattresses.

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Casper® ad on the number 6 subway line in New York City, photograph by author, 2017.

Further Reading:

References:
[1] McCully, Robert. “Vampirism: Historical Perspective and Underlying Process in Relation to a Case of Auto-Vampirism.” Vampires, Werewolves, and Demons: Twentieth Century Reports in the Psychiatric Literature, edited by Richard Noll, New York: Brunner/Mazel; 1992: p. 38.
[2] Ibid.
[3] Barber, Paul. Vampires, Burial, and Death: Folklore and Reality. New Haven: Yale University Press; 1988: 2-13.
[4] Ibid., 19.
[5] Ibid., 32.
[6] Ibid., 121.
[7] Ibid., 124-5.
[8] Ibid., 158.
[9] McCully, 83.
[10] Youngs, Giles R., ed. Dobson’s Complaint: The Story of the Chester Porphyria. London: Royal College of Physicians of London; 1998: 1.
[11] McEwin, Roderick. Porphyria in Australia: A Review of the Literature, and the Australian Experience. Sydney: Health Commission of New South Wales; 1975: 6.
[12] Lane, Nick. “Born to the Purple: The Story of Porphyria.” Scientific American. December 16, 2002.
[13] Youngs, 11.
[14] McEwin, 43.
[15] Ibid.
[16] Maranda, Eric Laurent et al. “Porphyria and Vampirism-A Myth, Sensationalized.” JAMA dermatology 152.9 (2016): 975.
[17] Gómez-Alonso, J. “Rabies: A Possible Explanation for the Vampire Legend.” Neurology 51.3 (1998): 856–859.