Red Medicine: The West Looks at the Soviet Experiment in the 1930s

By Paul Theerman, Associate Director, Library and Center for the History of Medicine and Public Health

Last month marked the 100th anniversary of the Great October Revolution, whereby the Bolsheviks in Petrograd overthrew the Russian government and took power.[1] Immediately after, the Revolution’s leader, Vladimir Lenin, consolidated his rule by suppressing competing political parties; withdrawing Russia from World War I; and fighting a bitter Civil War. By the early 1920s, the country had obtained a modicum of peace, albeit isolated from the rest of the world. Through wars and purges, technological advance and political suppression, the Bolsheviks, renamed the Communist Party, held control in Russia for almost 75 years.

In a Hospital Waiting Room, Moscow

Margaret Bourke White, “In a Hospital Waiting Room, Moscow,” 1932. Red Medicine, endpaper.

Lenin was aware of Russia’s backwardness compared with the West. He saw Communist rule as a way to make up for that deficiency. His oft-cited definition of communism made this belief explicit: “Communism is Soviet power plus the electrification of the whole country.” Soviet power meant political rule that flowed from ostensibly democratic workers’ councils (the Russian word for “council” is “soviet”), with the aim of basing governance in the working class; electrification meant providing the latest means of technological development. Soviet rule and technological development, together, would enable the country to leap-frog its capitalist neighbors and become the vanguard for humanity’s future development, both social and economic.

The socialist left hoped this vision would be realized. Early accounts were enthusiastic—sympathetic American journalist Lincoln Steffens gushed in 1919: “I have seen the future, and it works!”

By the 1930s, as the United States and Europe slid into the Great Depression, Soviet Russia was held out as a more workable and more equitable society than those in the West. In the field of medicine and public health, two observers set out to see if that were true. Sir Arthur Newsholme (1857–1943), and John Adams Kingsbury (1876–1956), a Briton and an American, traveled through the Soviet Union in August and September 1932.[2] Their account was published the following year as Red Medicine: Socialized Health in Soviet Russia.[3]

Itinerary of the authors

“Itinerary of the authors, who traveled 9,000 miles within Soviet Russia.” Red Medicine, p. 19.

Newsholme and Kingsbury travelled over 9,000 miles throughout the Soviet Union. Entering Russia from Poland, the two traveled to Moscow, took a trip up to Leningrad and back, and then headed east to Kazan, south to Samara and Stalingrad, and jogged back to Rostov-on-Don before journeying to Tiflis (Tbilisi) in Soviet Georgia. They traveled back to Moscow by way of Sochi, Sevastopol (in Crimea), and Kharkov in Ukraine, and from Moscow, they returned to Poland. Their book chronicled their trip with an overlay of commentary. It was in part a look at Soviet institutions, such as residential and non-residential treatment, physician training, maternity care, and tuberculosis sanitaria. Beyond this, the authors provided social and political observations on life in the Soviet Union, with chapters on “The Background of Russian Life,” “Stages in the Introduction of Communism,” “Women in Soviet Russia,” and “Religious and Civil Liberty and Law.”

Though clear-eyed about the authoritarian nature of the Soviet government, Newsholme (the acknowledged author of most of the work) nonetheless focused on one question:

Does the Soviet organization—including all that is implied in the unification of financial responsibilities and control of the entire resources of the country—assist to an exceptional extent a complete medical and hygienic service for the entire community? To this question we can at once give a definitely affirmative answer. [4]

Though the “civilized countries” had variously tended toward socialized medicine, he thought that the U.S.S.R. had surpassed them all, both in delivery of health care and in prevention, in social services as well as medicine more narrowly defined. As one reviewer of Red Medicine understood Newsholme’s claim:

“[In the] organization and practice of medicine . . . the present government has made truly great progress, and seems to have only fairly gotten under way. The authors clearly perceive that Russia has laid a more adequate basis for up-to-date public health than any western nation; also, that we have arrived at a stage of cultural development when medical services must be provided on a sound basis for all, regardless of ability to pay.”[5]

Traveling dental station

Soviet Photo Agency, “Traveling dental station in rural district near Moscow,” [1932]. Red Medicine, p. 223.

This level of public support was seen as the inevitable goal of social development, so much so that, as Newsholme put it, “Even if the Communist experiment fails, Russian government cannot be expected to revert entirely to capitalist conditions.”

Did the Soviet experiment work? The new system of medicine and public health was initially very successful in dealing with infectious disease and extending care more widely through the country. Nonetheless, as Newsholme had envisioned, the initial impetus could not be sustained. Fifty years after Red Medicine, the system was broken; while citizens could usually get access to health care, quality lagged. After the collapse of the Soviet system in 1989–91, the new Russian government attempted reform and adopted a mixed public-private economic model, mandating compulsory health insurance while continuing a guaranteed right to free care. Fifteen years on, though, an OECD report concluded that “Russia continues to struggle with a health and mortality crisis.”[6] One could fairly state that our country faces such as crisis today as well, and in both cases, the resolution is yet to come.

A note: Red Medicine includes several photographs by noted photojournalist Margaret Bourke-White, taken during her own 1932 trip to the Soviet Union, and provided freely to the authors for their use.[7]

Endnotes:
[1] Yes, it took place in November! In 1917, Russia still used the Julian calendar, according to which the day of the Bolshevik coup was October 25. The rest of the West, using the Gregorian calendar, called that day November 7. Most of Catholic Europe had switched to the Gregorian calendar in 1582, with the Protestant countries adopting it in the 17th century and the British domains in 1752. Russia made the change in early 1918, one of the last countries in Europe to do so.

[2] Newsholme was an eminent British public servant and advocate of state intervention in public health, while Kingsbury, a Fellow of The New York Academy of Medicine, was formerly Commissioner of Public Charities for New York City, and at that time, Executive Director of the Milbank Fund, a foundation supporting research in health policy.

See “Sir Arthur Newsholme, K.C.B., M.D. (LOND.), F.R.C.P.,” American Journal of Public Health 33(8) (August 1943): 992–94; John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885–1935, Cambridge History of Medicine (Cambridge: Cambridge University Press, 1997); Arnold S. Rosenberg, “The Rise of John Adams Kingsbury,” The Pacific Northwest Quarterly 63(2) (April 1972): 55–62; “Biographical Note,” The John Adams Kingsbury Papers, Manuscript Division, Library of Congress, accessed November 7, 2017.

[3] Sir Arthur Newsholme and John Adams Kingsbury, Red Medicine: Socialized Health in Soviet Russia (Garden City, NY: Doubleday, Doran, 1933). Note that, despite the title, the work was about more than Soviet Russia. The two men’s travels took them to the Georgian and Ukrainian Soviet Republics as well.

This work was conceived as in some ways completing Newsholme’s previous three-volume survey of medical practice in Europe, which he undertook with the support of the Milbank Foundation: Medicine and the State: The Relation between the Private and Official Practice of Medicine, with Special Reference to Public Health. London, Baltimore: George Allen and Unwin, Williams and Wilkins; 1932. The Academy Library holds the third volume.

[4] Newsholme and Kingsbury, Red Medicine, “Concluding Observations” (for this and subsequent statements).

[5] Frank H. Hankins, “[Review of] Red Medicine: Socialized Health in Soviet Russia. By Sir Arthur Newsholme and John Adams Kingsbury,” Social Forces 14 (1) (1 October 1935), 155–56, accessed November 7, 2017. Hankins (1877–1970) was a prominent American sociologist.

[6] William Tompson, “Healthcare Reform in Russia: Problems and Prospects,” Organisation for Economic Co-operation and Development, Economics Department Working Papers, No. 538 (Paris, January 15, 2007), 5.

[7] Gary D. Saretzky, catalog for “Margaret Bourke-White in Print: An Exhibition at Archibald S. Alexander Library, Rutgers University, New Brunswick, New Jersey, January–June 2006,” item 23, Red Medicine, accessed November 7, 2017.

Asthma and the Civil Rights Movement

Today’s guest post is written by Ijeoma Kola, a PhD candidate in Sociomedical Sciences at Columbia University Mailman School of Public Health and a former National Science Foundation graduate fellow. Her dissertation examines the history of asthma in urban African Americans in the 20th century, with special attention to medical history, environmental racism, and community activism. On Tuesday, November 14 at 6pm, Ijeoma will give the talk “Unable to Breathe: Race, Asthma, and the Environment in Civil Rights Era New Orleans and New York.” Click HERE to register for this event.

In July 1965, several months after the assassination of Malcolm X and the freedom marches from Selma to Montgomery, the New York Times ran a story about “an emotional epidemic” of asthma sweeping across New York City.[1] Although the writer focused on psychosomatic explanations to link asthma symptoms to the hostility of the Civil Rights Movement, it prompted me to explore the significance of asthma’s emergence as a racial problem during the 1960s.

Asthma Linked to Rights Drive

Osmundsen, John A. “Asthma Linked to Rights Drive.” New York Times. 1965.

Before the 1960s, little was written about asthma in African Americans. For much of the early twentieth century, doctors debated whether black people could have asthma, as they understood the disease to afflict middle and upper-class whites, who were believed to have more civilized lifestyles and delicate constitutions than poor blacks.[2]

However, in the 1960s, several “outbreaks” of asthma made national news headlines. In the fall of 1960, nearly 150 patients from adjoining neighborhoods were treated for asthma at Charity Hospital in New Orleans. One patient, a 73-year-old man, died.[3] After several years of seasonal asthma admission spikes in the same hospital, researchers at Tulane University found that asthma related visits to the emergency room correlated with fire department calls from spontaneous fires at the base of garbage heaps, some five to twenty years old, around the city. Smoke containing silica particles would drift downwind to where the majority of people who visited Charity Hospital, triggering asthma attacks.[4]

Air Pollution and NO Asthma

Lewis, Robert, Murray M. Gilkeson, and Roy O. McCaldin. “Air Pollution and New Orleans Asthma.” Public Health Reports 77, no. 11 (November 1962): 953.

Air Pollution and NO Asthma 2

Lewis, Robert, Murray M. Gilkeson, and Roy O. McCaldin. “Air Pollution and New Orleans Asthma.” Public Health Reports 77, no. 11 (November 1962): 948. with modifications.

At the time, however, the New Orleans asthma epidemic of November 1960 was quickly forgotten, as events over the course of the next few days would quickly turn attention away from asthma to something more urgent. A week after Dennis Knight’s death, on November 14, 1960 – four black 6-year old girls – Leona Tate, Tessie Provost, Gaile Etienne, and Ruby Bridges – began the school integration process at two elementary schools in New Orleans. Violent protests broke out across the city, and only 13 of the usual 1,000 students at the two schools attended on integration day.[5]

In New Orleans in 1960, and in several other American cities with a large concentrated black community over the next decade, asthma appeared to present itself alongside moments of racial tension. Although the New York Times connects these two phenomena with a psychosomatic explanation of emotional distress, I view the relationship differently. Neighborhoods where African Americans lived – often restricted to due to segregation and redlining – were more exposed to both indoor and outdoor particles that triggered asthma symptoms. While struggling to breathe, black people simultaneously fought for the right to live as equals. Rather than think of Civil Rights as a cause of asthma, I see asthma outbreaks in black urban America and subsequent efforts to reduce the asthma disparity as both a symptom and a symbol of the Civil Rights movement.

References:
[1] John A. Osmundsen, “Asthma Linked to Rights Drive: Authorities Note Sharp Rise in Ailment Among Negroes and Puerto Ricans in City CAUSE STILL UNCERTAIN Tensions of Fight for Gains Play at Least Some Role, Many Experts Contend,” New York Times, 1965.
[2] Horace F. Ivins, “Pollen Catarrh-Hay Fever,” in Proceedings of the Fourth Quinquennial Session of the International Homoeopathic Congress, Held at Atlantic City, N.J., U.S.A., June 16 to 22, 1891 (Philadelphia: Sherman & Co., 1891), 732–43.
[3] “Medics Puzzled:: Asthma Epidemic Hits New Orleans; 149 Seized, 1 Dead,” Philadelphia Tribune (1912-2001); Philadelphia, Penn., November 12, 1960, sec. 2.
[4] Robert Lewis, Murray M. Gilkeson, and Roy O. McCaldin, “Air Pollution and New Orleans Asthma,” Public Health Reports 77, no. 11 (November 1962): 947–54.
[5] John G. Warner, “Mob of 5000 Is Hosed By New Orleans Police: Police Hose New Orleans Segregation Rioters,” The Washington Post, Times Herald  (1959-1973); Washington, D.C., November 17, 1960.

Caring for a Collection of Seventeenth Century Ivory Manikins

By Scott W. Devine, Head of Preservation

The Gladys Brooks Book and Paper Conservation Laboratory recently completed the rehousing of a fascinating collection of seventeenth century ivory manikins (small sculptures which open to reveal details of human anatomy). As with most items that are treated in the conservation lab, recent consultation and study of the collection by a researcher provided the starting point for conservation assessment and a review of the current housing.

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Each manikin includes delicately carved features and is often attached to a support of carved wood. Finely detailed pillows are a common feature on items in the collection. Webster Anatomical Manikin Collection #27.

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In most female manikins, the abdominal wall removes to reveal tiny painted organs and a small fetus connected by a linen cord. Webster Anatomical Manikin Collection #27.

History of Ivory Manikins

The renewed interest in human anatomy following the publication by Andreas Vesalius of De humani corporis fabrica in 1543 resulted in a growing demand for écorché drawings which depicted anatomical cross sections of the human body. In addition to drawings, sculptors in France, Italy and Germany began to specialize in detailed cross sections of specific organs which could be used for anatomical study. Out of this tradition of producing three-dimensional study models, either molded from wax or sculpted from wood or ivory, grew the art of carving ivory manikins:

Quite apart from the écorché figures, the ivory eyes, ears and skeletons, yet another product of the carver’s skill was produced in considerable numbers during the seventeenth and eighteenth centuries. This was a small manikin of a man or a woman measuring from 12 to 24 centimeters in length with the anterior thoracic and abdominal wall removable to reveal the viscera. By far the greater number of these lie supine on a stand or in a fitted case and are carved in ivory; some stand on a small pedestal. Although they do occur in pairs, male and female, it is more common for single female figures to be found and in almost every case the figure is represented in an advanced state of pregnancy; the foetus being attached to the uterus by a red cord or else loose within the cavity.[1]

The term manikin is preferred as it denotes a figure with articulated limbs, the moveable arms being essential for allowing the removal of the abdominal wall.

The New York Academy of Medicine Library holds seven manikins, including a rare male and female pair. The manikins do not contain physical markings to indicate artist or date of creation. We do know that one of the largest producers of ivory manikins was Stephan Zick (1639-1715) of Nürnberg and that the Zick workshop produced possibly more manikins than any other workshop in Germany.[2]

Significance and Use

Unlike the detailed écorché figures designed for study purposes, it is unlikely that the manikins were used for teaching or instruction. The lack of detail on the internal organs would limit their function in this capacity. Le Roy Crummer (1872-1934) describes a female patient who remembers learning about pregnancy in 1865 with the aid of an ivory manikin, although such instruction does not seem to be the intended use of the manikins.[3] It is possible that the manikins were considered objects of curiosity, collector’s items that perhaps represented a growing interest in women’s health and the physiology of pregnancy. It is also conceivable that the manikins were given as gifts to newly married couples as good luck tokens intended to signify a future of healthy childbirth. Regardless of the original purpose, as art form the manikins represent an intriguing merger of Baroque art and science.

Designing a New Enclosure

Maintaining complex three-dimensional moveable objects such as the manikins is similar to the work required to preserve rare books in good working condition. In both cases, proper storage and housing are critical for long term preservation.  Enclosures designed for the delicate manikins must account for many moving parts, including fragile ivory fingers and tiny internal organs. The previous temporary housing consisted of wrapping the manikins in acid-free tissue and tying labels to each manikin, stacking them in a Coroplast® polypropylene box.  While this solution protected the manikins during storage, it did not allow for easy viewing and required a complex unwrapping and re-wrapping procedure to access each manikin.

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The previous temporary housing did not facilitate easy access and introduced the possibility of damaging the delicate manikins during the unwrapping process.

The new enclosure takes into consideration the needs of each manikin by creating a small custom designed tray with two types of polyethylene foam to make sure that each manikin fits securely inside each tray: dense Ethafoam® provides basic support and is lined with softer Volara® foam in areas where the foam directly touches the manikin. The trays are fitted with handles of linen tape that allow the tray to be removed from a larger housing without touching the manikin. The trays are designed to fit into pre-made archival boxes purchased from Gaylord Brothers. The pre-made boxes were retrofitted with Ethafoam® supports lined with Volara® foam. The addition of the Ethafoam® allows the boxes to be easily transported from the environmentally controlled stacks to the Rare Book Room, minimizing vibration and movement within the box.

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Yungjin Shin, Collections Care Assistant, designed the interior of the storage boxes, taking advantage of the box depth to fit as many trays in each box as possible. In this case, the manikin’s tortoise shell bed and pillow rest in a tray above the actual manikin, pictured in the next image. Webster Anatomical Manikin Collection #23.

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Chloe Williams, 2017 Pre-Program Intern, designed customized trays for each manikin, taking into consideration the contours of each object. Webster Anatomical Manikin Collection #23.

As an additional support, each tray includes a custom fitted pillow of Tyvek® filled with polyester batting that rests on top of each manikin. The pillows further minimize shifting within the box without introducing a rigid support that could damage the fragile ivory features of each manikin. Typical of most artifact housings, each box is labeled with a photograph of the contents so that there is no confusion about which manikin is inside.

6_BoxExterior_watermark

Boxes labeled with photographs allow for easy identification of contents without having to check inventory numbers or search for less obvious identification marks.

Gloves are used when the manikins need to be handled to reveal the intricate internal organs. In situations where the manikin needs to be removed from the tray, the placement of supports within each tray is intentional and designed to encourage the use of two hands when removing the manikin.

7_Gloves_watermark

The use of gloves when handling the manikins protects the item and allows for better control when handling the smooth ivory surface.

Working with this extraordinary collection has allowed the conservation staff to refine our skills in objects housing and to begin designing similar projects to preserve the rich collection of artifacts that complement the Academy Library’s rare book collection.

References:
[1] K.F. Russell. Ivory Anatomical Manikins. Medical History 1972; 16(2): 131-142.
[2] Eugene von Philippovich. Elfenbein. Munich: Klinkhardt und Biermann, 1981.
[3] Le Roy Crummer. Visceral Manikins in Carved Ivory.  American Journal of Obstetrics and Gynecology 1927; 13: 26-29.

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.

Dog

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?

SMJournals
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.

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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.
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