Melissa Grafe's blog

The “Great Risk” of “Opium Eating”: How Civil War-Era Doctors Reacted to Prescription Opioid Addiction

Written by Jonathan S. Jones The U.S. Civil War (1861-65) sparked a massive epidemic of opioid addiction among those who fought and survived the bloody conflict. The war mobilized millions of soldiers, hospital workers, and freedom-seekers, bringing people into contact with unfamiliar microbes, insects, and animals. This mass movement of bodies and pathogens resulted in extreme outbreaks of measles, smallpox, typhoid fever, and other deadly, terrifying diseases. Brutal technological innovations like the Minié ball caused ghastly, agonizing wounds, and men who survived often spent the rest of their lives in chronic pain. Military surgeons tasked with patching up wounded soldiers and treating the sick had their jobs cut out for them. Often-times army doctors were simply civilians pressed into service by circumstance, and they fell back on fundamental therapies to mitigate sickness and suffering. Opiates, the most common medicines in antebellum America, thus became defensive weapons in Civil War’s medical arsenal, “important to the surgeon as gunpower to the ordinance,” according to one military medical handbook. Opium pills, morphine injections, and laudanum (a blend of opium and alcohol) were some of the Civil War’s most widely used medicines. Opiates were marvelous painkillers—morphine and synthetic opioids are still standard palliatives today—and the medicines were also surprisingly useful for suppressing symptoms like diarrhea and coughing. Civil War armies could not have functioned without opiates, which surgeons doled out widely during and after the war to ailing soldiers. Opiates are addictive, however, and doctors’ prescriptions all-too-predictably led to addiction for Civil War veterans. Not only was opiate addiction dangerous and unhealthy, resulting in thousands of overdose deaths between the 1860s and the early twentieth century, but the condition was also deeply stigmatized in Civil War America. Most Americans considered addiction to be an unmanly and immoral vice. Addicted veterans deserved punishment, not sympathy, according to contemporary observers. Consequently, addicted veterans faced terrible outcomes, a theme I explore in a recent journal article investigating the experience of opiate addiction for veterans. Naturally, many addicted veterans blamed the doctors who first introduced them to opiates. But how did doctors react to veterans’ blame? Did they reject charges of culpability, or admit that prescriptions lay at the root of Civil War America’s opioid crisis? Did the crisis affect how doctors practiced medicine, and if so, what did any changes mean for the course of American medicine? These are questions I address in my book manuscript, “Opium Slavery: Veterans and Addiction in Civil War America,” which is based on my dissertation (Binghamton University, 2020). In 2020-21, as a postdoctoral fellow at Penn State’s Richards Civil War Center, I am revising my book for publication. My research for this project benefited immensely from a Ferenc Gyorgyey Research Grant awarded by the Harvey Cushing/John Hay Whitney Medical Library in 2018-19. The library’s inimitable collection of nineteenth-century American medical records provided a major component of my evidentiary base, allowing me to investigate how the Civil War veterans’ opiate addiction epidemic refracted into medical practices and thought in the late-nineteenth century U.S. In particular, the Medical Historical Library holds incredibly rare clinical records that provide insights into how the Civil War-era opioid crisis altered the fundamentals of medicine, like prescribing patterns. As I argue in my book, American physicians were deeply troubled by prescription opium and morphine addiction among veterans. Doctors were widely blamed for causing the post-Civil War opiate addiction epidemic by overprescribing opiates, and this blame was dangerous for physicians, who had a perilous position in the extraordinary competitive Gilded Age medical marketplace. The nineteenth-century American medical marketplace was remarkably democratic, and sick people could turn to a bewildering array of medical practitioners for health care. Throughout the Civil War era, physicians struggled to outcompete sectarian practitioners, patent medicine sellers, and so-called “quack” doctors. Something had to be done about prescription drug addiction, many physicians worried, because the problem threatened the profession’s reputation and commercial standing. Consequently, I argue, during the 1870s and 1880s, ex-military surgeons—men like Jacob Mendes Da Costa of Philadelphia’s Jefferson Medical College—urged their colleagues to prescribe opiates sparingly, thus creating fewer cases of opiate addiction. Not to be overlooked, this shift away from opiate medicines was a radical reversal of nineteenth-century American therapeutic practices, which relied heavily on opiates to treat all manner of ailments. Da Costa was a former Union army surgeon famous in his day for conducting research on cardiac distress among Union army soldiers and veterans. In an influential 1871 medical journal article, Da Costa urged his colleagues to refrain from prescribing opiates to men suffering from chronic pain, warning that there was “great risk of making the patient an opium eater”—a dual risk for patients' health and physicians’ reputations. I suspected that Da Costa, for his part, practiced what he preached. That’s what brought me to Yale’s Medical Historical Library. Considering his firsthand knowledge of addiction, I wanted to investigate how Da Costa’s prescribing patterns might have differed from his peers in reaction to witnessing addiction among soldiers. After the Civil War, Da Costa set up shop in Philadelphia, where he taught clinical medicine at Jefferson Medical College. At Yale during the spring of 2019, I quantified Da Costa’s patient records from the Jefferson Medical College’s public teaching clinic in Philadelphia. They document the medical histories of thousands of individuals suffering from a wide variety of painful conditions. The records include detailed prescriptions, and a sample of 1,945 cases dating from October 1870 to October 1875 indicate that Da Costa and his trainees prescribed opiates to just 371 patients, or 19%. By comparison, Yale historian John Harley Warner has found that about 42% of prescriptions from a comparable public hospital in Boston during the 1870s contained opiates—more than double the rate of Da Costa’s Philadelphia clinic. In other words, Da Costa and his medical trainees relied much less heavily on addictive opiate medicines than their contemporaries. Considering Da Costa’s vocal warnings about prescription opiate addiction—knowledge he gleaned by observing addicted Civil War soldiers and veterans—the Jefferson Medical Clinic records reveal that the Civil War veterans’ opiate addiction epidemic had important ripple effects on American medical practices. Opiate medicines, long-time staples in the doctor’s black bag, soon declined precipitously in American medicine. As I argue in my book, ex-army doctors like Da Costa, who were alarmed by veterans’ prescription opiate addiction, led the movement away from opiates. The research that led to these surprising findings would have been impossible without a Ferenc Gyorgyey Research Grant from Yale’s Medical Historical Library. By facilitating access to Da Costa’s rare clinical records, the grant played an essential role in my dissertation research and ongoing book project. About Jonathan S. Jones Jonathan S. Jones is the inaugural Postdoctoral Scholar in Civil War History at Penn State’s George and Ann Richards Civil War Era Center in 2020-21, where he is currently preparing a book manuscript on opiate addiction in the Civil War era for publication. The project is derived from his dissertation on the same topic, defended at Binghamton University in June 2020. Jonathan’s recent publications include an article in The Journal of the Civil War Era’s June 2020 issue titled “Opium Slavery: Civil War Veterans and Opiate Addiction.” After Penn State, Jonathan will be joining the Department of History at Virginia Military Institute (VMI) as an Assistant Professor starting in August 2021. Connect with Jonathan on Twitter at @_jonathansjones or at jonathansjones.net.

Finding Fulton in the Historical Library

While Harvey Cushing was the impetus behind the formation of Yale’s Medical Library, you can find materials on the other founders, John Fulton and Arnold Klebs, within the Historical Library’s main reading room. John Fulton, the youngest of the three founders of the Historical Library, trained in medicine and physiology at Harvard and Oxford, and came to Yale in 1930 as professor of physiology. He was already deep into collecting books when he served as a resident and disciple of Harvey Cushing at the Peter Bent Brigham Hospital. The two men shared a close friendship based on both scientific and historical interests. Like Cushing, Fulton became a bibliophile, bibliographer, and historian. His special collecting interest was physiological works from the 16th to 18th century. In addition to his major texts in physiology, Fulton authored or coauthored biographies of Harvey Cushing, Benjamin Silliman, and Michael Servetus, and bibliographies of Fracastoro’s poem Syphilis, Luigi Galvani and his nephew Aldini, Richard Lower and John Mayow, Joseph Priestley, Robert Boyle, and early works on anesthesia. Fulton became the first chairman of the Department of History of Medicine at Yale in 1951 with offices across the hall from the Historical Library offices. In 1956, Fulton wrote in his diary that his wife Lucia “had been at me to have a portrait done, and since Deane Keller [who had done Harvey Cushing’s portrait] thinks I am hopeless as a sitter and has refused to persevere with the several he started some years ago, I felt free to go to Sir Gerald.” So began a summer of sittings for the portrait of John Fulton sitting on the left side of the fire place in the Medical Historical Library. Sir Gerald Festus Kelly, who had painted portraits of the royal family including Queen Elizabeth, met with John Fulton for 40 sittings in the summer of 1956. The first sitting, from 2:30-6:45, involved Fulton stepping up on his platform and sitting in a “rather stiff Victorian armchairs with sundry pillows on the seat since my arm seem to be shorter than those of most of his subjects.” Over the course of the sitting, Fulton heard stories about Kelly’s interactions with artists such as Renoir. Fulton was “completely fascinated by the man,” and the time passed pleasantly until a series of photographs of Fulton were taken at the end of the session. “A series of loud and devastating expletives coming out from under the hood; his private photographer would have to take his vacation at this wrong time!” However, a secretary came in, grabbed the negatives, and stated she would develop and print them for Kelly. Fulton went home feeling that he had had “a cosmic experience.” Ensuing diary entries capture the details of sitting for the portrait, and more on Gerald Kelly, who had a variety of humorous and interesting anecdotes about various artists and prominent figures of the 20th century. Fulton wrote that in the final portrait, he is sitting at his desk in the Historical Library, although Kelly had never seen his desk, and used photographs to fill in details. Behind Fulton, there are representations of his books and diaries, which he wrote in from 1915-1960. The portrait currently hangs in the back of the Medical Historical, to the left side of the fireplace.

The DIY Historical Herbarium

Written by Alicia Petersen, PhD student, History of Science and Medicine Program (HSHM) Herbaria, collections of dried plant specimens that were (usually) adhered to sheets of paper, were very popular in 18th-century Europe. From professional botanists exploring the Americas to amateur scientists roaming the fields near their homes, many used herbaria to store preserved plants for later study. In order to better understand how early moderns “did” science, I decided to create my own herbarium (see the page below) following the guidelines for plant collection and preservation detailed in 18th-century British manuals. The simple act of following directions ended up being a bit more challenging than I had anticipated! Sitting on my bedroom floor, surrounded by an assortment of plant cuttings, I read and re-read 18th-century botanist William Withering’s instructions for plant preservation. Withering’s famous works contain directives like the following: “… specimens may be dried tolerably well between the leaves of a large folio book, laying other books upon it to give the necessary pressure: but in all cases too much pressure must be avoided.” (A botanical arrangement of British plants…, pg. xlvi) I couldn’t help thinking: that’s it? Withering fails to give his readers any indication of how much pressure is too much, a seemingly important detail. Other ambiguities led to a variety of errors on my part, including the burnt fern specimen pictured below. What’s more, when it came time to identify the specimens I’d collected, I found myself even more perplexed. Unable to rely on photographs or iPhone apps, it quickly became that 18th-century botany was like a foreign language. I needed to be fluent, but unfortunately, I only understood about every fourth word. This made for quite the adventure. The Medical Historical Library’s collections served as an important resource as I went tromping through the past. For this project, one object was particularly stunning: an actual 18th-century herbarium, complete with plant specimens that are over 250 years old. The herbarium dates back to the 1760’s and has been attributed to Frenchman Jean Seris, who is thought to have been a student at Paris’ Académie Royal de Chirurgie. While I relied on manuals like Withering’s to guide my collecting practices, I followed Seris’ example for format and layout. Perhaps my biggest takeaway from this project was the immense amount of knowledge required to engage in 18th-century natural history. Interacting with Seris’ herbarium, an object that represents knowledge in practice, provided even greater insight. By reading this “book of nature,” I was able to see 18th-century plants both through Seris’ eyes and my own. Below: Pages from Jean Seris’s Herbarium with dried specimens, 1761

Disability, Disability Activism, and the 30th anniversary of the Americans with Disabilities Act

Thirty years ago, the landmark Americans with Disabilities Act (ADA) became law, prohibiting discrimination against people with disabilities in all areas of public life, including employment, schools, transportation, and public spaces. This exhibition explores disability and disability activism leading up to the passage of the ADA in July 1990. At a local level, the exhibition discusses disability activism at Yale today, focusing on multiple groups advocating for change across Yale's system. On display in the Cushing Rotunda March 5th - December 2020

Explore Medieval and Renaissance Medical and Scientific Manuscripts

The Cushing/Whitney Medical Library is pleased to announce that our medieval and Renaissance manuscript collection is now online! The effort to digitize the manuscripts and make them freely available worldwide was generously funded by the Arcadia Fund. The manuscripts contain early medical and scientific knowledge on a variety of topics, including surgery, gynecology, medicine, herbs and remedies, anatomy, healthful living, astronomy, and mathematics. They are handwritten in Latin, Italian, Greek, German, and English. Some are illustrated, like MS18, De herbis masculinis et feminis [and other botanical and zoological works, including the Herbarium of Apuleius]. Turning the pages of this manuscripts reveals numerous hand-colored drawings of plants and animals, including the mandrake root. The mandrake root was valued for a variety of medical uses, including as an aid for reproduction. Mandrake root, as depicted in Harry Potter and in legend, would let out an ear piercing, killer scream when uprooted. Other manuscripts are filled to the very edges of the paper with text, including marginalia and commentary, like MS11, which has 24 different texts including Aristotelian treatises. The earliest work is the Bamberg Surgery, dating from the 12th century and purchased, like most of this collection, by Library founder and famed neurosurgeon Dr. Harvey Cushing. As medieval medical scholar Monica Green writes, “The Bamberg Surgery doesn’t get a lot of love in histories of surgery, because of its patchwork character. As [George] Corner himself said, “it is a notebook, a partially organized collection of notes, memoranda, prescriptions, and excerpts from other books.” Please explore these manuscripts on Cushing/Whitney Library site on Internet Archive, as part of the Medical Heritage Library. You can also find other Arcadia-funded digitized texts, including Yale Medical School theses and early Arabic and Persian books and manuscripts, in this collection. The Library plans to make the medieval and Renaissance manuscripts available through Findit, Yale University Library’s Digital Collections site.

Picturing Disability Technology

Our first 2018-19 Ferenc Gyorgyey fellow, Jaipreet Virdi, Ph.D., shares an aspect of her research on disability technology through photographs and postcards, with little help from Twitter… Picturing Disability Technology Written by Jaipreet Virdi* In a 2014 article, historian Katherine Ott expressed: “Both the artifacts owned and used by people with disabilities and those that are used upon them or that are encountered in life create possibilities, impose limits, assert political and ideological positions, and shape identity.”[1] This statement has guided my research on the material culture of disability and the nature of disability as both an individual experience and a collective one. By examining how disabled people created, modified, and used technologies, tools, and machines as a medium of social interaction, my work aims to conceptualize how such objects shaped the meanings and management of disability – to understand, as Toby Siebers has written, the ways in which objects are “viewed not as potential sources of pain but as marvelous examples of the plasticity of the human form or as devices of empowerment.”[2] My research also examines representations of disability technologies: how did disabled people ascribe meanings and values to their objects? Wheelchairs, canes, walkers, braces, spectacles, hearing aids, prosthetics, and etc., all color various interactions with disability. Since most of these technologies are essential for navigating (sometimes literally) the world, visual representations of disabled people with these technologies provides us with valuable insight for understanding people’s lived experiences of disability. In photographs, for instance, everything from poses, dress, props, and the inclusion of disability technology, are visual evidence of conscious decisions to frame an image of disability. Such images enable us to perceive the kinds of technologies people used, how they adapted them to their bodies, and how they personalized them to reduce the stigma of “otherness”[3] or “freakery.”[4] The Robert Bogdan Disability History Collection at the Medical Historical Library (in the Harvey Cushing/John Hay Whitney Medical Library at Yale University) contains over 3,500 photographs and ephemera representing disability. Since the 1980s, Bogdan had collected such representations, ranging from the 1870s-when photographic images became popularized—to the 1970s at the heights of the disability rights movement. Bogdan’s 2012 collaborative book with Martin Elks and James A. Knoll, Picturing Disability: Beggar, Freak, Citizen, and Other Photographic Rhetoric (Syracuse University Press), provides a broader historical context of the collection, including a history of different types of citizen portraits. The carte de visite was the most common photographic format from 1860 to 1885, with each photograph printed from a negative and mounted on a piece of thin cardboard; some people chose to have the photograph on a postcard, so as to send messages to family and friends. Cabinet cards were also popular at the end of the nineteenth century, though they were three times larger than the carte de visite. Citizen portraits were often taken at a local studio, positioning subjects to “echo family visual rhetoric, not disability conventions”—there is no obvious attempt to conceal the disability, for it is part of the family reality as conveyed in the photograph.[5] Other photographs also use props and positioning of people to convey “normal life” within an inconsequential setting to frame an image’s ordinariness, instead of using disability to define the situation.[6] Disability technologies and other visual indicators of disability are prominently present in many of these photographs. As Bogdan points out, “their presence is not so intrusive as to change this picture’s place in the category of atypical family photograph.”[7] In this wedding portrait, for instance, the two women in wheelchairs are part of the wedding party and positioned to provide balance—the same way a photographer will arrange individuals according to height to obtain symmetry in portraits—without drawing much attention to their wheelchairs. Wedding party with 2 women in wheelchairs, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. These photos also do not tend to specifically feature the disability object, rather positioning the people within normal portraiture conventions, whether it is to show romance or familial ties. The use of additional props, moreover, were used to further confine the photographs within portraiture traditions – the disability technology, though consciously included in the photos, are not the subject of the portrait. Rather, it is the people and their relationships with each other. As Bogdan asserts, “Although some of the images were shared, even sent through the mail, they were distributed privately to intimates, family members, and friends. They were not produced for commercial public relations, to solicit money, to sell, or for personal or organizational gain.”[8] Through these images, we can see most assuredly that people with disabilities were “too busy living to be restrained by our post-structuralist worries over the cultural contingencies of what they did or who they were,” as Ott has remarked.[9] Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. One series of photographs piqued my interest: of individuals outdoors in wheelchairs that have chains attached to the wheels. This design feature appears in different styles of wheelchairs, but I have never previously encountered it in my research, either in manuscripts and archives, or in material culture collections. Inspecting the photographs, I took an educated guess: would these be for raising or hoisting the individual from the chair? My guess didn’t seem right to me, so I took my question to twitter. As historians have discussed, crowdsourcing on social media is useful for harnessing participatory knowledge. It blurs the boundaries between specialist and non-specialist knowledge, offering new insights for working with primary sources. What seemed to me to be a questionable, confusing design feature was quite obvious to others – the wheelchair is a hand-crank, with the chains fixed to move the wheels the same way that a bicycle pedal moves a bicycle. Now, since I don’t own or ride a bicycle, chain gears were not something I was familiar with, but others have shared their knowledge to enable me to paint a better picture of how this design feature was useful for wheelchair users. The exchange on twitter formed a conversation about self-propelled wheelchairs that governed my research through the Bogdan collection and the broader history of the wheelchair. Litters, swings, cradles, carts, carrying-chairs or sedan chairs were used prior to the formation of the wheelchair as we know it, and individual chairs were not mass-produced until the mid-twentieth century to assist the increasing numbers of soldiers surviving from spinal cord injuries. Wheelchairs became associated with disability and thus, users were stigmatized and perceived as unable to contribute to society. These photographs, however, reveal the extent to which disabled people governed their own lives and sought to be self-sufficient, even taking an action pose in their studio portraits to represent their maneuverability. Man in wheelchair formed like a cart, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. As Penny Wolfson has shown, users relied on their own craftsmanship or that of others to shape a mobility device for their own needs.[10] Wheelchairs could be made by adding cart wheels on dining or library chairs, by repurposing motorcycle engines, or adding gears for hand-cranked wheelchairs. While most nineteenth-century wheelchairs were manufactured by furniture makers prizing comfort, adaptability, and mobility, some users repurposed from household furniture and included crafted additions for comfort: home-sewn cushions, crocheted blankets or feet mats, and trinkets attached to spokes. These features provide us with clues into the personalized relationship between user and technology, presenting experiences of disability that were not always negative or exclusive. Moreover, photographs of disabled wheelchair users in various settings—in a field, in the streets, on the porch—indicates the challenges of maneuvering within the built environment, especially of navigating on unpaved streets. The wheels, cranks, and other design features that are visible in the photographs additionally reveal variants of disability experience. By the 1970s, wheelchairs became markers of disability as well as symbols of activism, leaving behind intimate traces of their owner(s). And those hand cranks aren’t simply designs of the past; old designs can always be made new again. *Jaipreet Virdi is a historian of medicine, technology, and disability. She is an Assistant Professor in the Department of History at the University of Delaware. Her first book, Hearing Happiness: Fakes, Frauds, and Fads in Deafness Cures will be published by The University of Chicago Press. The Ferenc Gyorgyey Research Travel Grant generously supported this research; special thanks to the grant selection committee and to Melissa Grafe. Photograph images from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. You can find Jai on twitter as @jaivirdi. [1] Katherine Ott, “Disability Things: Material Culture and American Disability History, 1700-2010,” in Susah Burch and Michael Rembis (Eds.), Disability Histories (Chicago: University of Illinois Press, 2014), 119. [2] Toby Siebers, “Disability in Theory: From Social Constructionism to the New Realism of the Body,” in Lennard Davis (ed), The Disability Studies Reader (New York & London: Routledge, 2006), 177. [3] Catherine Kudlick, “Disability History: Why We Need Another ‘Other,” The American Historical Review 108.3 (June 2003): 768-793. [4] Rosemarie Garland-Thomson, Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York: Columbia University Press, 1997). [5] Robert Bogdan, Martin Elks and James A. Knoll, Picturing Disability: Beggar, Freak, Citizen, and Other Photographic Rhetoric (Syracuse University Press, 2012), 145. [6] Bogdan, Elks, and Knoll, Picturing Disability, 146. [7] Bogdan, Elks, and Knoll, Picturing Disability, 154. [8] Bogdan, Elks, and Knoll, Picturing Disability, 145. [9] Katherine Ott, “The Sum of its Parts: An Introduction to Modern Histories of Prosthetics,” in Katherine Ott, David Serlin, and Stephen Mihm (eds.), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York: New York University Press, 2002), 1-42; 3. [10] Penny Lynne Wolfson, “Enwheeled: Two Centuries of Wheelchair Design, from Furniture to Film,” MA Thesis, Cooper-Hewit, National Design Museum, Smithsonian Institution and Parsons the New School for Design (2014).

Secret Miracles of Nature

We have a secret! Blog post on an item in the Books of Secrets exhibit, by student curator Nell Meosky Levinus Lemnius (1505-1568) was a Dutch physician who served the community of Manhuissatraat for nearly fourty years, traveled throughout Western Europe, and was highly regarded for his work during epidemics in 1529, 1532, and 1537.[1] Late in life and after his wife’s death, Lemnius went to seminary and became a priest, a transition which informs much of his most well-known book, De Occultis Naturae, which was first published in 1564. [2]Nearly a century after Lemnius’s death, De Occultis Naturae (literally, “The Hidden Nature”) was translated into English by an unknown translator, and given the title The Secret Miracles of Nature.[3] Later, the work would be combined with a German manual on midwifery to produce Aristotle’s Masterpieces. Upon first glance, The Secret Miracles of Nature is an imposing book, much larger than other books of secrets of its day at approximately 11” by 7”. This is likely a sign that the printer was able to invest significantly in creating an impressive image for the book, supported by the robustness of the paper and binding that were used to construct it. Thanks to the reputation of Lemnius, who is described on the title page as “that great physician” and is acknowledged by scholars as well-respected, the printer was probably able to expect good sales of the book to higher class readers. The size of the book allows for more generous margins, which a reader could use to take notes on the recipes recorded within. The font of the text is somewhat larger than that of contemporary books of secrets, but not to scale with the size of the book, creating a formidable amount of reading to be done to reach the end of its 300-some pages. It does not appear, though, that the book was necessarily meant to be read from cover to cover in one setting, as it is made of up discrete recipes. The cover is worn and the edges of the pages, particularly at the very front and back of the book, appear almost charred, very brittle and dark. This suggests that the book was in fact used frequently, and the uneven staining of the pages hints that some of the sections may have been used more often than others. Although no readers’ names are recorded in the book, it seems to have been last owned by an individual around 1911, 250 years after its debut. Lemnius (or the translator) organized the volume into four discrete books: the soul and its immortality; plants and living creatures; diseases, their symptoms and cures; and other rarities. There is also a “bonus book” at the end, containing rules for how a man should lead his life. This book is particularly interesting because of Lemnius’s late-life career as a priest, and it begs the question of whether the four books were penned previously, with the fifth being added once Lemnius completed seminary. Within these books are many chapters, which are named quite descriptively and leave little room to imagine what is discussed on the pages indicated. This organization, and the abstract-like titles of chapters, makes it very easy to find the particular question that you are looking for an answer to – in fact, the titles could serve as something of an executive summary for those who do not wish to read the entire text. However, despite the clear organization of the books in their titles, their content overlaps. In book 1 (on the immortality of the soul), chapter V, Lemnius writes “of the strange longing of women with child, and their insatiable desire of things; And if they cannot get them they are in danger of life.” This chapter, while tangentially related to the soul because of the generation of a new soul through pregnancy, does not seem to quite fit the theme of the rest of the chapters of that book. However, after paging through the rest of the chapter, a logical flow begins to emerge: Lemnius begins with relationships between men and women, then to pregnancy and determination of gender (…the chapter on driving pests away from corn not withstanding). In content, The Secret Miracles of Nature is highly comprehensive, blending natural knowledge with philosophy.The language of the forward is difficult and arcane, but the language of the chapters is often easy to follow and engaging, and Lemnius addresses the book to “those that practice physic, and all others that desire to search into the hidden secrets of NATURE for the increase of Knowledge.” Lemnius often makes references to Hippocrates when explaining his medical decisions, and in book 2 includes disease knowledge from the rare and mystical to the most mundane: on physical phenomena, unnatural vs. natural death, the virulence of epidemics, and drunkenness. These medical portions are interesting in their blending of observation and experience with belief and religious texts; for example, on pg. 108 in Book II Chapter X: Every filthy smell is not hurtfull to Man, Lemnius observes of smells that “for some of these will difusse contagions, and resist corrupt diseases. By the way, whence came the Proverb, that horns are burnt there.” Lemnius was an author of great medical and spiritual prowess, and does not shy away from sharing his wisdom of both kinds in this, his greatest work. [1]PC Molhysen and PJ Block,New Netherland biographical dictionary. Part 8. AW Sijthoff, Leiden 1930. Accessed Oct 27, 2013 https://www.dbnl.org/tekst/molh003nieu08_01/molh003nieu08_01_1789.php 2 Charlotte F. Otten, Hamlet and the Secret Miracles of Nature. Notes and Queries (1994) 41 (1):38-41. https://academic.oup.com/nq/article-abstract/41/1/38/4593545 [3] Ibid.

A Vietnam War Surgeon Writes Home

The Kristaps J. Keggi Vietnam War service collection, recently donated to the Historical Medical Library, contains the complete correspondence between Dr. Kristaps J. Keggi and his wife, Julie, during his time as a surgeon in the Vietnam War. The materials were all donated by Dr. Keggi, the current Elihu Professor in Orthopedics at Yale School of Medicine. The scope of the collection—personal letters, photographs, teaching materials and war wound images- presents a unique and comprehensive look into the life of a war surgeon. Letters detail stories of MASH (Mobile Army Surgical Hospital), Montagnards plagued with leprosy, ceremonies with local tribes, a visit from a Playboy bunny and, of course, the extensive surgeries performed in a combat zone. A sample of photographs and letters are on display at the Historical Library.

Unveiling Medicine’s Past: Medical Historical Collections Online

The Medical Historical Library’s digital collection includes School of Medicine photographs, portraits of 16th Century anatomist Andreas Vesalius, Harvey Cushing, and others, medical and surgical instruments, prints, posters, and drawings, and much more! Recently, thousands of medical works from the 19th and early 20th centuries have been added to the Medical Heritage Library, an online resource of free and open historical resources in medicine. This exhibit, on view in the Medical Library Rotunda, Hallway, and Foyer, showcases a selection from the thousands of items currently available online, and describes the process of digitization, bringing medical history to users throughout the world with a few simple clicks. On view April 11 to July 5, 2013

Over 2600 International Health and Safety posters at the Medical Historical Library

In January 2013, the Medical Historical Library acquired a collection of over 2600 international public health and safety posters from 56 countries. Topics include maternal and child health, anti-drug and tobacco campaigns, breastfeeding, clean water, prevention of diseases such as malaria and polio, and accident prevention and safety. Kenya, The Netherlands, Oman, France, and Germany are particularly well represented in the collection. Posters issued by the World Health Organization (WHO), the Pan American Health Organization, and Doctors without Borders are also included. Please contact Melissa Grafe, melissa.grafe@yale.edu, for more information and for access to the posters.