Facendo Il Libro: The Making of the Book (and a digital collection and exhibit)

By Anne Garner, Curator, Rare Books and Manuscripts, and Robin Naughton, Head of Digital

The Academy Library is thrilled to announce “Facendo Il Libro: The Making of Fasciculus Medicinae, an Early Printed Anatomy.”  This online exhibit, focused on an astonishing and influential medical book first published in Italy in 1491, was made possible through the generous support of the Gladys Krieble Delmas Foundation.

Originally collected in manuscript form, the Fasciculus Medicinae (the “little bundle of medicine”) is a richly illustrated collection of medical treatises on uroscopy, phlebotomy, anatomy, surgery, and gynecology.  The Fasciculus Medicinae was first published in 1491, but demand for it made it a favorite text for printers. By 1522, it had been issued more than twenty times.  Variations in the text and the illustrations through time show the early modern tension between medieval medical ideas and advances in medical understanding forged at the beginning of the 16th century.  The exhibit allows visitors to browse full-text scans of all five editions (1495–1522) in The New York Academy of Medicine’s collections; to investigate each edition’s exquisitely illustrated woodcuts and to explore their cultural and medical meanings; and to compare the books’ illustrations in different editions over time.  The site includes contributed essays from Dr. Taylor McCall, art historian of material culture and medieval medicine at the Walters Art Gallery, Baltimore, and from Dr. Natalie Lussey Seale of the University of Edinburgh, whose work focuses on early modern Venetian print culture.  Dr. McCall’s essay looks at the creation of the text and its accompanying illustrations, while Dr. Seale’s essay offers a window into Venetian printing processes in the 16th century and describes the making of a book in early modern Italy.

frontispiece_1495_watermarked

Frontispiece, 1495.

The illustrations of the Fasciculus Medicinae offer an intriguing glimpse of medical practice in the 16th century.  The book’s woodcuts include narrative scenes depicting the earliest Western depiction of dissection in print, an early illustration of a diagnostic consultation showing a professor analyzing a urine flask, and a physician, holding an aromatic sponge to his nose to avoid infection, attending a sick plague patient confined to his bed.  Other woodcuts help us to understand early modern conceptions of health and illness.  The Fasciculus Medicinae’s female anatomical figure captures late medieval ideas about women’s bodies, reproduction, and pregnancy.  A “Wound Figure” graphically depicts the various threats to the body, from blows to the head down to the prick of a thorn on the feet.  Perhaps most surprising of all, the Fasciculus Medicinae’s “Zodiac Figure,” who balances all twelve zodiac signs on his body, conveys the powerful role the stars and planets played in health in the medieval imagination.  This figure, who dates to earlier manuscripts from the medieval period, survives well into the twentieth century, appearing alongside horoscopes in a modified form in print in American almanacs produced by pharmaceutical companies.

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Delmas Homepage imageThe Facendo Il Libro website has a simple design, but a complex structure.  It is both a standalone digital collection and an online exhibit built using Islandora, an open-source digital repository framework.  Representing the first full-text internal digitization project for the Academy Library, the five editions of the Fasciculus Medicinae were digitized in the Library’s Digital Lab. The online exhibit was built using an Islandora multi-site to leverage the digital collection repository (Fedora), Drupal Book module, and the current Library branding theme.

The ability to draw from the common repository made it possible to store content once and use it in multiple ways.  Thus, the five digitized editions are available in two different places using a single source.  The built-in navigational structure for the exhibit makes it easy for users to explore the collection in a linear fashion or by sections.

First images of the 1500 edition

Replicating the physical experience of touching the text is still a challenge for digital projects.  Thus, it was important to create a digital experience that provides the user with some sense of the materiality of the object. For example, the 1500 edition was bound with another text (Savonarola’s Practica medicinae), which is evident from the first digital image of the book. The image shows the thickness of the text and the fact that the 1500 edition begins in middle of the physical object. It shows the user exactly what will be encountered when using the physical item.  It also highlights a significant piece of information that could have been lost due to cropping.

Another important aspect of the online exhibit is the illustrations page, where users can see all the illustrations from all editions in one place.  When a user clicks on an illustration, the user is immediately taken to a page with descriptions of each illustration as it appears in each edition.  To explore the images, users can click on an image and zoom in to see the intricate details.

Facendo Il Libro: The Making of Fasciculus Medicinae, an Early Printed Anatomy” offers a great opportunity for users to learn and explore the Library’s five editions of Fasciculus Medicinae in context.

Explore Facendo Il Libro Online Exhibit.

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The British National Health Service and the Fight for Universal Health Insurance in the United States

Today’s guest post is by Andrew Seaton, the 2018 Paul Klemperer Fellow in the History of Medicine. Andrew is a History PhD candidate at New York University. His dissertation explains the survival of the British National Health Service since 1948, and its significance at home and abroad. Andrew will be presenting his Fellowship research on Wednesday, April 18, at 4 p.m. in the Hartwell Room. Please email history@nyam.org if you would like to attend. Space is limited.

Americans have often looked to other countries in their debates about extending health insurance. Health reformers in the Progressive Era held up Germany’s sickness insurance as a model to work toward, only to have this turned against them during the First World War.[1] In the postwar period, the British National Health Service (NHS) became a focal point of discussion. President Truman’s attempts to include “national health insurance” within existing Social Security legislation coincided with the establishment of the NHS in 1948. When Truman’s opponents – foremost among them the American Medical Association (AMA) – depicted the NHS as emblematic of the problems with “socialized medicine,” (see image below) progressives rushed to its defense.

Figure1_watermark

Typical representation of the British National Health Service by the American Medical Association. “The Rebellion of British Doctors,” Editor and Publisher, March 6 1948.

The left-wing health economist, Michael M. Davis – whose papers are housed in the New York Academy of Medicine historical collections – stood as a central advocate for the British model. Davis was one of the most important American health campaigners of the mid-twentieth century. He founded organizations such as the Committee for the Nation’s Health (CNH) in 1946 to promote national health insurance, and worked closely with Truman to achieve legislative reform.[2] Cognizant of attacks in the Progressive Era on the German model, the CNH realized that AMA “misinformation” about the British scheme would seriously harm their chances of securing their goal of comprehensive health coverage for all. Responding to this threat, the CNH rebutted AMA communications on the NHS in their own pamphlets (see image below), provided statistics and details about the British health service to newspaper editors, and reprinted favorable media coverage from the U.K.

Figure2_watermark

Committee for the Nation’s Health, “The Truth About Britain’s Medical Program” (March, 1949).[3]

Trans-Atlantic trips undergirded American battles over the NHS. Dozens of opponents and supporters of extending health insurance in the U.S. undertook field studies in Britain to aid in the battle back home. Davis – by this point nearly eighty years old – undertook such a trip in 1959 with his wife, Alice. They not only met with their extensive contacts in the medical profession and British civil service, but also spoke to ordinary people in public parks across the country to find out how they felt about the NHS. The Britons that Michael and Alice Davis met – from hotel maids to university professors – were “practically unanimous” in saying they “wanted the Health Service,” pointing to the end of anxieties about doctors’ bills as the main cause of satisfaction.[4] The following year, Davis presented these findings as a talk to various American community and labor organizations in an attempt to stimulate interest in national health insurance.

Despite these efforts, Davis and other progressives lost their battle with the AMA. Congress struck down Truman-era health bills, the CNH ended its activities in 1956, and trade unions turned towards securing the best deals for their members through private health insurance rather than advancing a federal health program. The reputation of the NHS played an important part in these events; the AMA’s negative vision of the NHS triumphed over that presented by figures like Davis. This underlines the importance of transnational perspectives when thinking about the history of health care in America – and indeed in Britain – alongside the significance of convincing a wider public when attempting to enact structural change. If Davis’s dream of universal medical coverage in the U.S. is ever to be realized, it will rest in part on shaping popular opinion about America’s place in the wider world of health systems.

References:
[1] Beatrix Hoffman, The Wages of Sickness: The Politics of Health Insurance in Progressive America (Chapel Hill: The University of North Carolina Press, 2001), 54-74.
[2] For a biography of Davis, see Alice Taylor Davis, Michael M. Davis: A Tribute (Chicago: Center for Health Administration Studies, 1972).
[3] New York Academy of Medicine, Library of Social and Economic Aspects of Medicine of Michael M. Davis, Box 64, CNH Releases on British N.H.S., “The Truth About Britain’s Medical Program” (March, 1949).
[4] New York Academy of Medicine, Library of Social and Economic Aspects of Medicine of Michael M. Davis, Box 62, Bibliography: England: 2, Michael M. Davis, “My Observations Last Summer of the British National Health Service” (1960).

Diagnosing Love:  A Look at Classical Sources

By Anne Garner, Curator, Rare Books and Manuscripts

1Galen_galenilibrorum_1525_v1_frontispiecedetail_watermark

Frontispiece from Galeni librorum (1525)

In lyric from the 7th Century BCE, Sappho offers the famous description of the symptoms of lovesickness:

My heart beats (but my blood is gone)
At the sound of your sweet laugh.
I cannot look at you for long,
I cannot speak.

My tongue is wounded, and a light
Flame runs beneath my skin.
In my eyes there is no sight,
But my ears roar.

Dank sweat and trembling pass
Where my body was before.
I am greener than grass,
I am almost dying.

(Sappho fragment 2, translation by Willis Barnstone).[1]

For Sappho, love is an affliction, with all the attendant symptoms of a bad fever: Beset by cold sweat, drumming ears, and shaking, the speaker of Sappho’s poem has also gone green.  Her lines also allude to another physical response to falling  in love, one taken up by Galen, Hippocrates, and other classical writers interested in clinical observation and diagnosis. Sappho’s description of the heart, with fire pulsing under the skin, suggests that love may also cause a spike in pulse rate.

Texts from Greek and Roman medical authorities support the idea that an increase in pulse rate might signal an unrequited love.  Both men and women were susceptible to physical illness as a consequence of desire in stories told by Appian, Plutarch, Valerius Maximus, Galen, and others; later sources in the early modern period, especially Dutch genre paintings like those of Jan Steen (see below), often argue that the malady is largely a female ailment.

2dixon_perilouschastity_steenimage_fig5

Jan Steen’s The Doctor’s Visit (c.1663). Taft Museum of Art (Cincinnati, Ohio).

Many of the earliest Greek prose accounts in classical writing date much later than Sappho.  Lovesickness is not mentioned at all in the core Hippocratic corpus, comprised of approximately seventy collected works by multiple authors in Ionic Greek.  And yet, the Greek physician and writer Soranus (fl. 1st / 2nd century CE) tells a story about the physician Hippocrates of Kos, born around 460 BCE. When Hippocrates visits the sick and lethargic king Perdiccas of Macedonia, he notices that his pulse increases each time Phyle, the wife of Perdicca’s deceased father, is near.  His health improves remarkably once Phyle establishes herself at his bedside (and, we are to infer, in his bed).[2]

The Roman physician Galen (130–210) relates the case of the wife of one Justus, kept awake at night by an ailment that she is reluctant to discuss.  After examining and questioning her, Galen suspects her to suffer from melancholy.  But when a visitor to the woman’s sick bed mentions he’s just seen a performance by the dancer Pylades, Galen writes that the woman’s “facial expression changed, and observing this and putting my hand on her wrist, I found that her pulse had suddenly become irregular in several ways, which indicates that the mind is disturbed.” Galen recounts that when other dancers are mentioned the woman’s pulse remained unchanged.  Pylades, Galen concludes, and her love for him, are at the heart of her illness.[3]

Galen also discusses the case of one Prince Antiochos, the son of the king of Syria (ca. 294 BCE).  Antiochos’ story appears in Appian’s Syrian Wars. King Seleucus the Conqueror, sick with worry over Antiochos’ sudden illness, brings the great physician Erasistratus to his son’s bedside. Erasistratus examines him, but can’t find any signs of disease.  When he questions him, Antiochos is close-lipped.  Erasistratus stations himself near the young man’s bed, and watches his physical symptoms when people enter and leave the room.  As Appian describes it:

He found that when others came the patient was all the time weakening and wasting away at a uniform pace, but when Stratonice [his stepmother] came to visit him his mind was greatly agitated by the struggles of modesty and conscience, and he remained silent. But his body in spite of himself became more vigorous and lively, and when she went away he became weaker again.

Erasistratus persuades the king to give Stratonice to Antiochus to marry, the only possible solution for his incurable disease.[4]

4ovid_artoflove_1931_frontispiece_watermark

Frontispiece of Ovid’s The Art of Love (1931).

All of these fallen hearts in the writings of Galen and others beg the question: how to treat a lovesick patient? The answer varied, depending on the source. The physicians in stories by Soranus and Galen conclude that relief could be found only in consummation of the relationship.  For others, the answer was more complicated. Ovid, who wrote more than a hundred years before Galen, is emphatic about the necessity of ridding oneself of desire. In his Remedia Amoris (“Remedy of Love”), a poem enumerating the cures for lovesickness, he writes:

I believe in drastic treatments only, for there can be no cure without pain. When you are ill, they deny you all the good things you crave and feed you nothing but bitter physic, and yet you suffer it willingly enough to save the health of your body. You must submit to the same treatment to save your mind, for it certainly is as precious.[5]

So what course does Ovid prescribe?  Ovid seconds Galen’s conclusion that sex with the desired person is a good idea, but makes the suggestion that the desired should be positioned in the most unflattering light possible.  If that doesn’t work, he advises the sufferer to avoid poetry (except presumably, his own), and move to the country.

5emblemataamatoria_ca1690_cupidwithcaduceus_watermark

Philip Ayre’s Emblemata amatoria (c.1690)

References:
[1] Sappho & Barnstone, W. Poems. Los Angeles: Green Integer, 1999.
[2] Jody Rubin Pinault. Hippocratic Lives and Legends. Leiden: E.J. Brill, 1992; Michael Stolberg. Uroscopy in Early Modern Europe. Surrey: Ashgate, 2015.
[3] Corpus Medicorum Graecorum, V, 8, 1.  Accessed online February 7, 2018. pp.101-103.
[4] Horace White and Appian, Syrian Wars. New York: Macmillan, 1899.
[5] Ovid and Charles D. Young.  “Remedy of Love.” In The Art of Love. New York: Horace Liveright, c 1931.

Expanding Access to Biodiversity Literature: Medical Botany

By Robin Naughton, Head of Digital and Arlene Shaner, Historical Collections Librarian
Cross-posted at The Biodiversity Heritage Library blog.

The New York Academy of Medicine Library has contributed nine digitized titles (11 volumes) on medical botany to the Biodiversity Heritage Library (BHL) as part of the Expanding Access to Biodiversity Literature project.   It is very exciting to share some of the Academy Library’s botanical resources with the wider public.

While the Library’s collections include a large number of printed botanical books dating back to the beginning of the sixteenth century, for this project we were interested in identifying resources that could be sent to the Internet Archive for external digitization, which meant that we concentrated on our holdings from the second half of the 19th century forward through 1922.  After generating lists from our online catalog, we checked to see if any of these resources had already been digitized by the BHL, Internet Archive, or HathiTrust.  For this process, we developed a set of simple guidelines.

  • Resources not available via BHL, Internet Archive or HathiTrust remained on the list.
  • Resources already available via the BHL were eliminated from the list.
  • Resources already available via the Internet Archive were eliminated from the list because BHL harvests content from the Internet Archive, so there would be no need for us to digitize that content.
  • Resources already available via HathiTrust could still potentially be digitized for access via the BHL based on whether our copy provides additional information for the public once digitized. For example, the Indian Medicinal Plants (Kīrtikara & Basu, 1918) has been partially digitized by HathiTrust, but the volume with the images was missing. As such, it became important for us to digitize so that it would be fully available.

We went through multiple lists and rounds of de-duplication to narrow down our potential submission.  Once we finalized the list, Scott Devine, Head of Preservation, conducted a conservation assessment to determine which resources could be sent out for digitization and which were so fragile that they could only be digitized in house.  We separated these into two lists.  The first list was sent to the Internet Archive for digitization and is our contribution to BHL.   The second list will be a project for our new digital lab and we hope to make them available at a future date.

Fig2

Indian Medicinal Plants (1918), plate #256 showing Leea Sambucina.

The Indian medicinal plants (Kīrtikara & Basu, 1918) stood out as a resource to digitize and share widely.  It documents the medicinal plants found in India.  The authors describe a need to provide a text that reproduces illustrations of Indian medicinal plants from other works since there were few prior to this publication.  Dr. W. Roxburgh’s text, reprinted in 1874, was used as a reference throughout.

Although Indian medicinal plants did not focus on the use of plants in the development of drugs, this theme can be seen throughout the resources submitted to the BHL. Each author grapples with the role of plants in the creation and production of drugs.

Fig3

A course in botany and pharmacognosy (1902), plate #1 showing organized cell-contents.

In A course in botany and pharmacognosy (1902), Henry Kraemer, Professor of Botany and Pharmacognosy, defines pharmacognosy as the “study of drugs of vegetable origins.” Kraemer devotes the first part of his text to plant morphology and the second part to pharmacognosy.  In addition, he provides illustrations to aid in the study of both parts so that students can connect the descriptions throughout the text to the visual representations.

Fig4

Pharmaceutical Botany (1918), fig 57 showing leaf bases, species and compound leaves.

Youngken’s Pharmaceutical botany, 2nd edition (1918) was expanded to take advantage of the growing area of botany, including a section on drug-yielding plants.  The text focuses on the morphology and taxonomy of plants used in drug development.

In Pharmacal plants and their culture (1912), Schneider argues that the majority of imported plants used in medicine could already be available in the United States.  He focuses on California and outlines what can be cultivated and grown in the state.  Schneider provides a list of uses and common names.

The medicinal plants of Tennnessee (1894) is an observational inventory of Tennessee’s plants and their descriptions based on a similar project conducted by North Carolina.  Published by the Tennessee Department of Agriculture, the report emphasizes the importance of documenting and understanding the native plants of Tennessee and how they can help increase usage and revenue.

Overall, readers of this collection can begin to understand the role of plants in the creation, development and economic viability of drugs.  Many of the resources provide some form of inventory, index or list that documents the plants and associated drugs.

All titles submitted by the Academy Library to BHL:

The BHL Expanding Access project is funded by the Institute of Museum and Library Services (IMLS).

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.

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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.

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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.

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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.

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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.