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Henbane, belladonna, hemlock, mandrake, yew – ingredients for a witch’s potion? Or plot devices in a Shakespeare play? 

Why not both? 

Just like modern crime writers study ballistics and crime scene procedure, Shakespeare studied botany at a near-expert level (or at least we can assume he did, based on the knowledge displayed in his portfolio). Shakespeare scholar Edward Tabor even speculates that the bard not only read the herbals of the time but possibly knew John Gerarde, a leading Elizabethan botanist who lived across the street during Shakespeare’s time in London (pg. 82). 

As Tabor documents, many of Shakespeare’s plots culminate around plant poisons: Romeo and Juliet’s dual suicide, the death of Hamlet’s father, the witch’s potion in Macbeth, and so on. 

Many of these plants had both positive and negative applications in the renaissance world: as anesthetic, aphrodisiacs, psychedelic, and poison. But have these classic botanicals passed out of modern use? Or do they continue in some form, quacky or otherwise? 

In this article, we’ll be looking at the role of plants in Shakespeare and whether they – or their derivatives – have found any home in modern medicine.

Henbane [Hyoscyamus niger]

Hamlet's Ghost: With juice of cursed hebenon in a vial,

And in the porches of my ears did pour

The leperous distillment

- Hamlet, Act I, Scene 5,59-73

One night out on the parapet, Hamlet – literature’s first mopey grad student and the son of the recently deceased king – is visited by his father’s ghost and learns of his fratricidal uncle Claudius, who supposedly poured henbane/hebenon in the dead king’s ear. And while Hamlet never questions how his dad attained this knowledge while sound asleep, he questions most everything else as he investigates literature’s most famous poisoning. 

H.C. Selous' depiction of Claudius pouring poison in the ear of a sleeping King Hamlet.
H.C. Selous, 1870. As Tabor reports, Shakespeare’s contemporaries considered the ears a gateway to the rest of the body (pg. 88). 

In antiquity, henbane was used as a sedative, containing the narcotic alkaloids scopolamine and hyoscyamine (USDA, The Powerful Solanaceae: Henbane). Shakespeare’s contemporaries understood henbane’s analgesic properties but also its lethality; botanist John Gerarde reports henbane delivering a “sleep deadlie (sic) to the party” (Tabor, 1970, pg. 88). Used also as a hallucinogen, henbane has long been associated with witches because it can induce sense of flight (USDA) and visions of “insane marvels” (Tabor, pg. 88). 

A medieval depiction of witches given flight due to supernatural powers.
Before the German purity laws (Reinheitsgebot) that limited beer to barley, hops, and water, beer was frequently spiked with henbane (USDA). We can only assume that game night was a much wilder time.

Did Henbane Make It?

Yes! The alkaloid hyoscyamine is an antispasmodic isolated from henbane and used to treat cramps, IBS, and other abdominal issues as a GI tract relaxant. And while inconclusive, some researchers have looked into henbane’s potential as an anti-parkinsonian drug. Hyoscyamine is branded as Anaspaz, Ed-Spaz, Levbid, Levsin, Levsin SL, NuLev, Oscimin, Symax Duotab,and Symax SL.

The Garden Poppy [Papaver Somniferum]

Lady Macbeth: I have drugged their possets, 

That death and nature do contend about them

Whether they live or die.

-Macbeth, Act II, Scene II, 6-8

Powder of white Poppie seede (sic) given to children in milke or possite drinke (sic), or an alebrew, or rather with a Caudell of Almonds and hempe seeds, causeth them to sleep. 

-Langham (pg. 507) 

In order to scheme the murder of king Duncan, Lady Macbeth spikes his servants ale, possibly (as some scholars speculate) with the humble poppy seed (Tabor, pg. 86). Known as a soporific, Langham (a contemporary botanist of Shakespeare) reports a recipe for crushing poppy seeds into a drowsy syrup (ibid): seeds that contain morphine and codeine, two powerful opiates, which “remain in the liquid when the seeds are removed” (Mayo Clinic). Such a poppy-derived "drowsy syrup" is referenced by Iago in Othello (Act III, Scene 3, 330). Elizabethans it seems, like the modern rapper, could claim to have “codeine in their cups.” 

Still Life with Nautilus Goblet, Willem Claesz Heda, 1642. A lavish dinner table is depicted with a shell-shaped goblet and half eaten pie.
Still Life with Nautilus Goblet, Willem Claesz Heda, 1642

Opium has played such an outsized role in history that prolonged comment is not needed. From the romantic poets and their Xanadus of earthly delight to Sherlock Holmes slumming in the opium dens, poppy has been used (and frequently abused) to relieve pain and achieve altered states of consciousness throughout recorded history.

The Smokers, Honore Daumier. A painting of two distressed gentleman in a smoky café.
The Smokers, Honore Daumier

Did Opium Make It?

Ever hear of the Sackler family?

The Wild Pansy [Viola Tricolor]

Oberon: Yet marked I where the bolt of Cupid fell.

It fell upon a little western flower,

Before, milk-white, now purple with love's wound,

And maidens call it “love-in-idleness.”

Fetch me that flower, the herb I showed thee once.

The juice of it, on sleeping eyelids laid,

Will make or man or woman madly dote

Upon the next live creature that it sees.

-A Midsummer Night's Dream, Act 2, Scene 1, 165-172

An essential ingredient to the plot of A Midsummer Night's Dream, the wild pansy (which supposedly, when applied topically could induce a libidinous frenzy) is used by Oberon, king of the Fairies, to mess with his estranged wife Titania. But of course, hijinks ensue.

While the pansy's many names reflect its folk-aphrodisiac status – names such as heartsease, love in idleness, or johnny jump up (MedicineNet, Heart's Ease) – the Elizabethan herbals do not report any lust-inducing associations with the plant, only its anti-syphilitic properties (Tabor, pg. 84), which, at least by the next century would have been much appreciated.

Shakespeare, therefore, was working within 16th century folk traditions rather than medical knowledge, but this is understandable, considering that Gerarde and Langham's herbals are filled with aphrodisiacs. Consider the innocent sweet potato, which was known to "procure bodily lust with greedinesse (sic) (Tabor, pg. 83). Candied fruits, like dates, were especially potent when "prepared by cunning confectioners" (ibid). The cotton seed was thought to "increase naturall seede (sic)" and, according to Gerarde, were much in use (ibid).

Love potions have been the staple of fairy tales, and while not a poison in the strictest sense, a classic of witch's brews as well. While the tragedies use poisons in their advance towards death, the comedies use herbs in their march towards love. Both show a sustained human interest in wielding substances towards our desired end state.

Did the Pansy Make It?

Well, not exactly. Science may not indicate the pansy's amorous powers, but it continues to be used alternatively to treat skin disorders like eczema (MedicineNet). Moreover, some have researched its potential as an immunosuppressant. Due to the presence of flavonoids and catechins, heartsease probably has anti-inflammatory effects as well (MedicineNet).

Mandrake [Solanaceae]

Cleopatra: Give me to drink mandragora.

-Anthony and Cleopatra, Act I, Scene 5, 4

While less plot-important than the other list-items, mandrake played a central role in medieval and ancient herbology and appears frequently in Shakespeare. A narcotic and soporific, Cleopatra requests mandragora to let her sleep through her lovesickness. Iago also mentions the soporific quality of the mandrake root in the same breath as opium (Othello, Act III, Scene 3, 330). And Juliet demonstrates Shakespeare's awareness of the common mythology, comparing her distress to the mandrake, which could only be uprooted in moonlight, lest its shrieks drive insanity (USDA, Mandrake).

A medieval depiction of the male and female mandragora roots.
A medieval depiction of mandragora

Like henbane, mandrake had many uses, including as a hallucinogen.

Did Mandrake Make It?

Yes! Mandrake root contains the alkaloid scopolamine, which is FDA approved to treat motion sickness and nausea derived from opiate analgesia (NIH, Scopolamine). Scopolamine is sold as Transderm Scop, Scopace, Maldemar, as well as generically.

Wolfsbane [Aconitum variegatum]

Laertes: And for that purpose I'll anoint my sword.
I bought an unction of a mountebank
So mortal that but dip a knife in it,
Where it draws blood no cataplasm so rare,
Collected from all simples that have virtue
Under the moon, can save the thing from death
That is but scratched withal. I'll touch my point
With this contagion, that if I gall him slightly,
It may be death.

-Hamlet, Act IV, Scene 7, 141-149

After investigating king Hamlet's poisoning, well, lots of stuff happens, and everyone dies. In this case, Hamlet duels his rival Laertes, who happens to have poisoned his sword. A poison begins the plot, and a poison ends it.

A classic depiction of a fencing dual, with one man thrusting and barely missing his opponent.

While Laertes does not specify the poison, the leading contender is wolfsbane or aconite (derived from wolfsbane). Elizabethans knew of aconite's poisonous potential, specifically as an arrow poison; Gerarde records swelling, madness, and death within the half hour from introduction (Tabor, pg. 89). Presumably, the plant garners its folk-appellation from its ability to ward off wolves and werewolves (National Poison Control Center, Aconitum napellus (Monkshood): A Purple Poison). The National Poison Control Center reports modern cases of aconite poisoning, some worthy of a true-crime drama.

Did Aconite Make It?
No. While aconite can be detoxified and purchased in herbal shops, it's also "responsible for the majority of serious poisonings from Chinese herbal preparations" (National Poison Control Center). Information about herbal use can be found here.

References:

May, M. (N.D.). Aconitum napellus (Monkshood): A Purple Poison. National Capital Poison Center. https://www.poison.org/articles/why-is-monkshood-considered-a-poison--174

Khan, S. (2024). Heartsease. MedicineNet. https://www.medicinenet.com/heartsease/article.htm

Lai, B. (2024). Poppy seed tea: Beneficial or dangerous? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/drug-addiction/expert-answers/poppy-seed-tea/faq-20559907

The Powerful Solanaceae: Henbane. (N.D.). United States Department of Agriculture. https://www.fs.usda.gov/wildflowers/ethnobotany/Mind_and_Spirit/henbane.shtml#:~:text=The%20pale%20yellow%2C%20bell%2Dshaped,carelessly%20used%2C%20even%20by%20herbalists.

The Powerful Solanaceae: Mandrake. (N.D.). United States Department of Agriculture. https://www.fs.usda.gov/wildflowers/ethnobotany/Mind_and_Spirit/mandrake.shtml

Shakespeare, W. (1597). Romeo and Juliet. Folger Shakespeare Company. https://www.folger.edu/whats-on/romeo-and-juliet/

Shakespeare, W. (1604). Hamlet. Folger Shakespeare Company. https://www.folger.edu/explore/shakespeares-works/hamlet/read/.

Shakespeare, W. (1622). Othello. Folger Shakespeare Company. https://www.folger.edu/explore/shakespeares-works/othello/read/

Shakespeare, W. (1623). Anthony and Cleopatra. Folger Shakespeare Company. https://www.folger.edu/explore/shakespeares-works/antony-and-cleopatra/

Shakespeare, W. (1623). Macbeth. Folger Shakespeare Company. https://www.folger.edu/explore/shakespeares-works/macbeth/read/.

Shakespeare, W. (1623). A Midsummer Night's Dream. Folger Shakespeare Company. https://www.folger.edu/explore/shakespeares-works/a-midsummer-nights-dream/

Riad, M. Hithe, C. (2023). Scopolamine. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK554397/#:~:text=Scopolamine%20is%20a%20medication%20used,the%20anticholinergic%20class%20of%20drugs

Tabor, Edward. (1970). Plant Poisons in Shakespeare. Economic Botany 24 (1), pp. 81-94. https://www.jstor.org/stable/4253115.

Autumn weather is here and we’re starting to see hints of fall foliage!  In the coming weeks, spend some time outdoors to enjoy the weather and colors, and to capture those amazing photos. 

Enter your best photo with a chance to win a PRIZE. All digital photos submitted will be showcased in the online 2024 Himmelfarb Fall Colors Photo Gallery, and prints will be displayed in Himmelfarb Library.

To get inspired, see our blog posts from past Himmelfarb photo contests.

How to Enter and Contest Rules:

Photo submission dates:  Monday, October 14, 2024 – Friday, November 8, 2024.

  • Who may enter: GW students, faculty and staff affiliated with the School of Medicine & Health Sciences, Milken Institute School of Public Health, and School of Nursing.
  • Complete a 2024 Online Contest Submission Form and submit an original photo (JPEG, PDF, PNG files only; file size maximum 10MB). 
  • Limit 1 entry per person.
  • Contest photo must be original and taken by the submitter in 2024.
  • Submitted photos will be displayed in online and print galleries with the photographer's name and photo title.
  • By submitting an entry, each contestant agrees to the rules of the contest.

Judging:

Photo entries will be judged based on creativity, originality, and overall artistic impact. One winner will be chosen by a prior contest winner and members of the Healthy Living @ Himmelfarb Committee.

*Himmelfarb Library reserves the right to cancel the contest or modify rules at its discretion. Himmelfarb Library reserves the right to reject any entrant whose entry appears off-topic or violates the rules.

For questions, contact: Deborah Wassertzug (deborah.wassertzug@gwu.edu)

A healthcare professional looking at a clipboard

Physician Assistant Week occurs from October 6-12 each year. This is an opportunity to celebrate PAs across the globe and in our own community. The Physician Assistant program at GW was founded in 1972, and the joint PA/MPH degree was launched in 1986. GW’s program was the first joint degree program for PA students in the US, according to program director Bart Gillum.

The PA program, ranked in the top five in the US, lasts 24 months, the PA/MPH program is 36 months. The Washington, DC location of the program makes the PA program an excellent place for PAs in training to take part in an annual leadership and advocacy summit sponsored by the AAPA, and to avail themselves of other opportunities to visit Capitol Hill to advocate on health policy.

When asked about three things that people might not know about the PA profession, Bart Gillum shared the following thoughts:

  1. "We are now "Physician Associates." In 2021 the American Academy of PAs voted to change the name from physician assistant to physician associate. While some states and institutions have already adopted the name, the new title is still in progress. Adopting the new name has been slow due to the requirement of state laws and healthcare institutions to be updated. In the meantime, you might continue to hear physician assistant and physician associate or even just PA  interchangeably."
  2. "Unlike physicians who undergo residency training for a specific specialty, PAs have the unique ability to move between medical specialties without additional formal training. A PA can work in areas such as cardiology, emergency medicine, or dermatology and switch to another field. This provides more flexibility for those who want to work in a variety of settings throughout their career."
  3. "While PAs are most prevalent in the US. PAs or PA-like professionals are present in about 15-20 other countries, including Canada, the UK, Australia, The Netherlands, Germany, South Africa, and New Zealand. Other countries are currently exploring incorporating PAs in their healthcare systems."
Infographic on physician assistants from AAPA.org
Physician Assistants at a glance (https://www.aapa.org/download/80021/)

Himmelfarb Library has many resources available to support PA students, beginning with the Physician Assistants research guide. Here you will find links to textbooks and videos, resources for diagnosis, a guide especially for PA/MPH students on doing a literature review, PANCE prep materials, resources for clerkship, and much more.

Don't forget to thank a physician assistant this week -- their important work expands patient access to healthcare. Tune in to both Good Morning America and the TODAY show on Friday morning, October 11, for a chance to see PAs representing their profession!

Two jack of lantern pumpkins shine in darkness

With October upon us, comes celebration of spooky season. The classic signs of Halloween approaching are here: theaters show scary movie marathons for those who want thrills and frights, skeleton and ghost decor begins to grace front yards and debate over what to wear for the event itself reaches a fever pitch. But witches, ghosts, and ghouls weren’t always reserved for just Halloween. In fact, some legends were born out of explanations for very real phenomena that used to strike terror across villages.  

One particular example comes to mind. The year is 1788. Your friend has fallen ill recently. She’s lost a lot of weight, she has a fever, and her skin is growing paler by the day. She has even started coughing up blood. Even worse, these symptoms mimic that of her late brother, who died a few months previously.  Thankfully, a neighbor has identified the culprit and knows the solution: dig up her brother’s corpse, cut out his heart, and burn it. 

Wait, what? As strange as it sounds, this was a real series of events that happened in New England. Before the Germ Theory of disease, people needed explanations for the spread of disease. While bad air (Miasma Theory) or the four humors were potential explanations, when it came to the disease known as tuberculosis, vampires were offered as a potential explanation (1). 

The original legend was brought over by immigrants from European countries (2). While the exact way vampires worked depended on the region, the general idea was that those who died came back to drain life from the living, often their family members. Given how tuberculosis spreads, family members did become ill, especially given members of one family might share the same bed. Digging up the corpse of the deceased family member was seen as a way to stop the illness and put it to bed at last. Given the cold winters in the region, sometimes bodies would be well preserved when they were dug up, further playing into the idea that the dead were feasting on the living. While the burning of organs didn’t actually do anything, in the face of an invisible illness, it provided those afraid with a feeling of some agency. 

The vampire legend doesn’t arise solely from tuberculosis, but some hallmarks of the blood suckers can be traced to the pathogen: the pallor vampires are known for, along with sleeping in coffins. Other aspects of the mythical monster are hypothesized to come from other illnesses. Vampire’s aversion to light (photophobia), running water and biting others may all originate from rabies cases. Those afflicted with rabies can showcase these symptoms, and those who wrote early vampire stories may have drawn inspiration from the deadly disease (3). Symptoms of the genetic disease porphyria have also been attributed to perhaps inspiring the myth as it also causes issues with being in the sun (4).

Thankfully, we eventually figured out the real culprit behind tuberculosis wasn’t the walking dead, but a bacterium, and that we could defeat it with antibiotics, not wooden stakes. But it’s important not to judge those who believed in the vampire theory too harshly. They had figured out the contagious part of the disease. They only misattributed the vector. 

So this October, remember where part of the fear of vampirism comes from. It’s not fangs, or gothic mansions, or poor book adaptations. Instead, think of those who latched onto the legend as an explanation, who knew something deadly was spreading, but didn’t know where to look or where it would strike next. 

1. Blanding M. Vampire panic gripped New England in the 1800s. the real evil was in the air. Boston Globe (Online). Oct 27 2023. Available from: https://www.proquest.com/newspapers/vampire-panic-gripped-new-england-1800s-real-evil/docview/2882529806/se-2. 

2. Groom N. UNEARTHING THE DEAD: Medicine and Detection, Body and Mind. In: The Vampire. A New History. Yale University Press; 2018:23-40. doi:10.2307/j.ctv6gqxp2.9

3. Gómez-Alonso J. Rabies: a possible explanation for the vampire legend. Neurology. 1998;51(3):856-859. doi:10.1212/wnl.51.3.856

4. McGrath J. Are vampires real? scientists have linked diseases and decomposition to all the historical tropes of nosferatu. Business Insider. Oct 21, 2023. Available from: https://www.proquest.com/newspapers/are-vampires-real-scientists-have-linked-diseases/docview/2879550637/se-2. 

What do librarians do anyway? If you want to find out, check out the comic below!

Panel 1:
Narration:  When people think of librarians, they often picture the following: an older woman with glasses and a cardigan.
Image: A librarian, who looks as the narration described, shushes the audience. 

Panel 2:
Narration: Who mainly spends her time shushing people, reading and sitting at a desk.
Image:The same librarian from the first panel sits at a desk with a sign that says “silence is mandatory”
Panel 3: 
Narration: Like all stereotypes, some folks do fit the mold demographically, the realities of the job are much different than what folks expect. 
Image: Rebecca, a librarian with brown curly hair and glasses, shrugs and says “honestly, I can’t remember the last time I shushed anyone.”
Panel 4: The tools librarians use might look different in the digital age, but the basic goal of ensuring information is accessible and discoverable remains the same. 
Image: A stack of books is placed next to a laptop.
Panel 5: To achieve this goal, along with other library functions, there’s actually a wide variety of types of librarians. 
Image: A librarian building is held up by the silhouettes of five people of various body types and skin colors.

Panel 6: Let’s take a closer look at some of the variety out there…
Image: There are eight boxes, each featuring a different person. The box labeled Circulation contains a heavy set pale blonde man with glasses. The Acquisition box  contains a lean person of older age with gray hair, brown skin and wrinkles. The box labeled Serials contains a man with dark skin and dreads, wearing a red suit. The box labeled Scholarly Communication, has a medium sized woman with tan skin and black hair. The box labeled childrens has a heavy set black woman with her hair in two buns, smiling. The box labeled Specialists, features a lean tan man with a goatee and wrinkles with graying hair. The box labeled archivists features a pal skinned red headed woman with glasses. The last box contains Rebecca, and is labeled reference.
The circulation librarian sits at a desk, facing the audience. He says “Circulation doesn’t just check out books, but things like chargers, electronics or even dry erase markers.”
Panel 8: Like circulation acquisitions can also be a team effort. Acquisitions involves ordering and acquiring new material for the library.
Image: The acquisitions librarian sits behind a stack of books, saying “an acquisitions librarian works with vendors and publishers to acquire material”
Image: A laptop is open on a desk and on the screen is the serials librarian. He says “these days many serial publications can be found digitally.”

Panel 10: In academic libraries, scholarly communication librarians help students and faculty alike publish their work. This can be by helping journals to publish in or managing an institutional repository. 
Image: The scholarly communications librarian is in a sailor’s outfit on a tiny boat, where a shark swims. She says “when it comes to avoiding predatory publishers, we can help.”

Panel 11: Children’s librarians work with children and young adults. They help select material for different age groups and organize events and outreach for patrons. Storytime for young kids is a good example of an event they run. 
Image: The children’s librarian sits in front of a group of children with a picture book she is reading out loud. Behind her is a teddy bear and books.
Panel 12: Specialists librarians work in special libraries where the often specialize in a topic or field. Law librarians and medical librarians fall into this category.
Image: The specialist librarian stands in front of a cabinet with a scale on it. He says “around one-third of law librarians have a law degree”

Panel 13: Archivists aren’t the same as librarians but they often have the same masters degree. They are specialists in preserving material and helping people access it. 
Image: The archivist reads a book in front of a desk and several file cabinets
Panel 14: Reference librarians, like myself, help people do research and find materials. They may also specialize in a topic or subject area.
Image: Rebecca stands in a hedge maze, with a torch. She says “There’s so much material to look through it can feel like a maze. Our job in reference is to help people navigate that maze.”
Panel 15: There are other types of librarians not mentioned here, such as library directors, as well as library jobs that are done by staff. Both librarians and library staff are essential to keeping the library running.
Image: a puzzle in the shape of a library is shown 

Panel 16: TThe things that tie libraries together are our commitment to some shared ideals.The American Library association has a whole list of professional standards and guidelines on its website.
Image: The ALA logo is shown

Panel 17: There are initiatives to recruit librarians from underrepresented groups and organizations dedicated to supporting these groups. 
Image: Rebecca is shown, saying “there are efforts to also recruit librarians from underrepresented groups.”
Panel 17: Libraries seek to protect intellectual freedom and preserve privacy. The American library association opposed the Patriot Act and in 2006. Four connecticut librarians went to court regarding gag orders. 
Image: Uncle Sam stands in front of an American flag, saying “I wasn’t trying to spy on patron records…I just wanted…uh. Book recommendations.”

Panel 18: Libraries also promise literacy and not just for books.
Image: Different types of images are shown next to types of literacy: a computer with computer literacy, a stethoscope next to health literacy, a dollar next to financial literacy, a ballot box next to civic literacy and a phone next to media literacy.
Panel 19: Teaching, instruction, budget management, programming, research: all of these skills are needed to keep libraries going.  
Image: two shelves are shown with different kind of hats on them. The hats are labeled with different kinds of library skills.

Panel 20: And only one of them, on rare occasions, is to shush people. END
Image: Rebecca stands in front of two shelves and a reminder to keep quiet on the second floor. She winks as she says “shush”
  1. Acquisitions | ALA. American Library Association. May 5, 2009. Accessed September 16, 2024. https://www.ala.org/tools/topics/atoz/profresourcesacquisitions/acquisitions
  2. Serials | ALA. American Library Association. April 29, 2010. Accessed September 16, 2024. https://www.ala.org/tools/atoz/Serials/serials
  3. Education. American Association of Law Librarians. Accessed September 24, 2024. https://www.aallnet.org/careers/about-the-profession/education
  4. What’s an Archivist? National Archives. June 7, 2022. Accessed September 19, 2024. https://www.archives.gov/about/info/whats-an-archivist.html
  5. ALA Standards & Guidelines | ALA. American Library Association. June 13, 2008. Accessed September 25, 2024. https://www.ala.org/tools/guidelines
  6. Vinopal J. The Quest for Diversity in Library Staffing: From Awareness to Action – In the Library with the Lead Pipe. In the Library With The Lead Pipe. January 13, 2016. Accessed September 25, 2024. https://www.inthelibrarywiththeleadpipe.org/2016/quest-for-diversity/
  7. Elliott J. Remember When the Patriot Act Debate Was All About Library Records? ProPublica. June 17, 2013. Accessed September 20, 2024. https://www.propublica.org/article/remember-when-the-patriot-act-debate-was-about-library-records

Televisions and stereos line a wall

With September in full swing, folks might find themselves short on downtime as exams and courses wind into full gear. Thankfully, this month’s medical media recommendation from our new Scholarly Communications and Metadata Librarian, Brittany Smith, is a sitcom that might be easy to sneak watching an episode during a tight schedule. 

Known for its humor and heart, Scrubs is a sitcom that ran from 2001-2010 that follows a group of interns and continues throughout their residency at Sacred Heart Hospital(1). While the show centered around its lead J.D, it also spent time building out its extended cast such as fellow residents Turk and Reid, nurse Carla Espinosa, Doctor Cox and the mysterious Janitor. Winning multiple awards, the wacky series wasn’t afraid to get silly despite the medical setting; there was even an entire episode that was a musical. 

Despite the zany antics, what really made Scrubs a treat to watch was its heart. The show “wrestled with the humanity of the characters in a meaningful way,” said Smith. Both patients and the physicians are shown as real people, and when Scrubs tackled those moments, it did so with empathy and thought. Some examples include a doctor struggling with OCD, the loss of a fellow staff member, and how losing patients can impact those who care for them (2). 

Scrubs can be streamed on multiple streaming services online. 

Works Cited

1.Scrubs. Doozer, Towers Productions, ABC Signature; 2001.

2. Pantoja K. Scrubs: 15 Saddest Moments, Ranked. ScreenRant. June 23, 2019. Accessed September 12, 2024. https://screenrant.com/scrubs-tv-show-saddest-moments-ranked/

Every country’s medical system works slightly differently. While here in the United States we can face frustrations related to insurance, high costs and other issues, that doesn’t mean other medical systems have no issues. For today’s installment of Medical Media, librarian Deborah Wassertzug recommends a television series that takes a look at the system across the pond: the National Health Service of the United Kingdom. 

This is Going to Hurt is a limited series television show from the UK, based on a memoir of the same name. Both the memoir, written by former doctor Adam Kay, and the television show, focus on the issues, struggles and experiences of junior doctors working in a National Health Service hospital, specifically their work on the obstetrics and gynecology ward. 

For those used to medical television that takes place in the United States, there is a lot of new terminology to get used to. For example, instead of residency, the UK has Doctor Specialty training (1). Despite these changes in terminology, the issues facing doctors will likely be familiar to those aware of the challenges medical professionals face in the United States: burnout, stress, overwork, and funding shortfalls. The show also tackles serious issues related to mental health issues and work-life balance among doctors, a trend also seen in the United States (3). One episode juxtaposes a private maternity hospital with an NHS hospital and raises the question of whether there are safety issues associated with “going private.”

The show isn’t entirely serious: there are lighthearted moments and its genre is likely best described as a black comedy. According to Wassertzug , the show juxtaposes hilarious scenes  with serious things people go through in medical settings, to great effect. Due to the involvement of Kay, the show is generally accurate when it comes to the dirtier aspects of medicine, so things do get a little messy. 

For those interested, the book and series can be found on Hoopla from public libraries, on consortium loan here at Himmelfarb, and the television series can be found on multiple streaming platforms online. 

1.

How Doctor Specialty Training (Residency) Works in the UK. BMJ Careers. Accessed August 21, 2024. https://www.bmj.com/careers/article/how-doctor-specialty-training-residency-works-in-the-uk

2.

Johnson A. CDC Tries Fixing Emerging Crisis: Mental Health Problems Among Doctors, Nurses. Forbes. Accessed August 21, 2024. https://www.forbes.com/sites/ariannajohnson/2023/11/01/cdc-tries-fixing-emerging-crisis-mental-health-problems-among-doctors-nurses/

3.

Doctors’ titles explained - Toolkit for doctors new to the UK - BMA. The British Medical Association is the trade union and professional body for doctors in the UK. June 28, 2024. Accessed August 21, 2024. https://www.bma.org.uk/advice-and-support/international-doctors/life-and-work-in-the-uk/toolkit-for-doctors-new-to-the-uk/doctors-titles-explained

Picture of Alice in Wonderland
John Tenniel, Public domain, via Wikimedia Commons

Did you know that several medical terms find their etymological origins in classic literature? Let this list inspire your next read!

First up, we have Pickwickian syndrome, which gets its name from Charles Dickens’ novel The Pickwick Papers. Officially called “obesity hypoventilation syndrome,” Pickwickian syndrome is defined as the combination of a high body mass index, high levels of carbon dioxide in the blood, and disordered breathing during sleep (Masa et al., 2019). Despite its name, Pickwickian syndrome refers not to main character Samuel Pickwick, but rather to the supporting character Joe, whose main personality traits are eating a lot of food and falling asleep constantly. The term Pickwickian syndrome originated in a 1956 case report in the American Journal of Medicine.

Next, there are several psychological conditions that bring to mind the experiences of literary characters. You might have heard of Alice in Wonderland syndrome, in which the patient has distorted perceptions of the size and shape of their body (Blom, 2016). The term was first coined by John Todd in 1955 in reference to the growing and shrinking Alice experiences when she consumes magical treats in Lewis Carroll’s classic Alice’s Adventures in Wonderland.

Another term taken from children’s literature is Peter Pan syndrome. This is an unofficial diagnosis, not recognized in the DSM (Diagnostic and Statistical Manual). It refers to adults who are socially immature and have trouble facing adult responsibilities. They wish that they would never have to grow up, like the eternally young Peter Pan from J. M. Barrie’s stories. Dan Kiley coined the term in his bestselling 1983 book The Peter Pan Syndrome: Men Who Have Never Grown Up.

Of course, the great playwright William Shakespeare makes an appearance on this list. Othello syndrome describes a paranoid delusional jealousy in which the patient becomes certain that their partner is cheating on them (Kataoka & Sugie, 2018). In Shakespeare’s play Othello, the antagonist Iago uses trickery to convince Othello of his wife Desdemona’s infidelity, leading to tragic consequences.

Our last entry is a bit different, but interesting enough to merit inclusion on this list. Doctors might complain about a patient by calling them a gomer. A gomer is someone who is frequently admitted to the emergency room but does not actually require medical care, or more broadly, as the Oxford English Dictionary defines it, “a difficult or disagreeable patient, esp. an elderly one.” Although the definitive origin is unclear, Samuel Shem popularized the term in his 1978 novel The House of God, in which he states that the word is an acronym of “Get Out of My Emergency Room.” Shem was a practicing psychiatrist, and his novel is about the disturbing experiences of a group of interns at a fictionalized version of Boston’s Beth Israel Hospital. 

So what will you be reading next? 

References

  1. Bickelmann, A. G., Burwell, C. S., Robin, E. D., & Whaley, R. D. (1956). Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. The American journal of medicine, 21(5), 811–818. https://doi.org/10.1016/0002-9343(56)90094-8
  2. Blom J. D. (2016). Alice in Wonderland syndrome: A systematic review. Neurology clinical practice, 6(3), 259–270. https://doi.org/10.1212/CPJ.0000000000000251 
  3. “Gomer, N. (3).” Oxford English Dictionary, Oxford UP, December 2023, https://doi.org/10.1093/OED/9986910637 
  4. Kataoka, H., & Sugie, K. (2018). Delusional Jealousy (Othello Syndrome) in 67 Patients with Parkinson's Disease. Frontiers in neurology, 9, 129. https://doi.org/10.3389/fneur.2018.00129 
  5. Masa, J. F., Pépin, J. L., Borel, J. C., Mokhlesi, B., Murphy, P. B., & Sánchez-Quiroga, M. Á. (2019). Obesity hypoventilation syndrome. European respiratory review: an official journal of the European Respiratory Society, 28(151), 180097. https://doi.org/10.1183/16000617.0097-2018
  6. Todd J. (1955). The syndrome of Alice in Wonderland. Canadian Medical Association Journal, 73(9), 701–704.

One of the most frequent questions we get at the library in recent months is in regards to A.I. What is A.I? Is A.I the future? Are we all about to be replaced by robots? In this month's comic strip, we simplify A.I. in order to make sense of what's realistic, what's plausible and what's still science fiction.

Speech Bubble 1:Ever since AI burst onto the scene, I’ve seen a lot of folks misunderstand how it works. 
Image: Rebecca, a librarian with light skin and dark curly brown hair in a ponytail speaks in front of a bunch of tech items.
Panel 4: 
Narration: In reality, while AI can write or talk, it’s not “thinking” like humans do 
Image: The robot displaying a blank expression is next to a thought bubble showing binary code.
Narration: To understand how AI “thinks” we need to understand what this kind of AI is and how it works.
Image: There is a monitor and on it, a pixilated version of Rebecca is shown next to the text “Understand A.I.” Then under that is the text A: Y B: N
Panel 6: 
Narration: First, the kind of AI seen in movies is not the same kind in chat-gpt. That is, self-aware AI currently doesn’t exist outside of fiction.
Image: Two books are shown. One of the books has a picture of a robot on it stating “foolish: it is statistically unlikely to be lupus” The title of the book is “Watt.Son M.D”
Panel 7: 
Speech Bubble: The AI we see discussed today is known as generative AI. It can produce things like text, images and audio by being trained on large amounts of data (1).
Image: A flow chart is shown. A bunch of file cabinets is first, then an audio icon next to the text or then a picture of a monitor next to the text or and then a smiley face drawing.
Panel 7:
Narrator: I’m going to vastly simplify. Say we want an AI to make images of sheep. First we’d grab a bunch of images of sheep as our training data. 
Image: A table is covered with a variety of photos of sheep. The sheep are all different sizes and colors.
Panel 8:
Narration: Over time, as we feed the model more pictures of the sheep, the model starts to identify common shared characteristics between the images. 
There is a little white sheep with a black face. Next to it, text states: Aspect: fluffy Feature 2(ear) Feature 2(eye) feature: tail= sheep
Panel 9:
Narration: Now, when this works as intended, after tons of images, our AI can start to produce images of sheep itself based off the training data. This is why it’s called “generative” AI; it is generating new content.
Image: The robot from early has an excited expression on it’s monitor. It points to a fridge where a picture of a sheep is displayed.
Panel 10:
The AI is able to produce these images not because it now “knows” what a sheep is, but by essentially large scale probability. I’m still vastly simplifying, but the AI makes the sheep fluffy not because it knows what wool is, but because 100% of its training data includes wool. 
Image: Rebecca stands in front of a television screen. On the screen, the robot looks confused at a black sheep in a field. 
Panel 11: 
Narration: So if we apply this to words, AI is not so much writing as it is calculating the probability of what word is most likely to follow the word it just typed. Sort of like autocorrect. 
Image: The background is a thunderstorm. There is text that reads: it was a dark and stormy _____? A. Night 90% B. Evening 7% C Afternoon 2% D. Day 1%
Panel 12: 
Narration: Okay so why bother making this distinction. Why does it matter?
Image: The robot is shown with it’s monitor displaying a buffering message. Above it, a chibi Rebecca says “let me explain.” 

Panel 13:
Narration: AI relies on its training data. Let’s consider the sheep example from earlier. In the photos I drew, none of them show a sheep’s legs. 
Image: Rebecca sits in front of her tablet with a drawing pen. She gestures to the viewer, exasperated. 
Rebecca ‘s Speech Bubble: “Look, I only have so much time to draw these things.”
Panel 14: 
Narration: If all the images I feed our hypothetical AI are of sheep from the middle up we might get something like this.
Image: Three pictures of sheep are displayed. None of the sheep have legs and instead are puffballs of wool. One sheep is square shaped.
Narration Con: Our AI can only generate based on its data. So if we feed it no pictures of sheep with legs, we get no pictures of sheep with legs (frankly is also shouldn’t make images of a sheep where the entire body is in the frame either). The backgrounds will be a mashup too, as the AI will consider it as part of the image. This leads to interesting results with a wide range of background types.
Panel 15:
Narration: This is one of the reasons AI images struggle with details like fingers: how many fingers you can see in an image of a person varies widely depending on their pose and the angle of the photograph (2).
Image: Four hands with different skin tones are shown, each with a different gesture. In a little bubble to the left, Rebecca is shown looking tired.
Rebecca Speech Bubble: Drawing hands is hard…
Panel 16:
Narration: The same thing goes for writing: when AI writes out “it was a dark and stormy night” it has no comprehension of any of those words. It’s all based on probability. And this is the misconception that leads to so many problems.
Image: The robot is seated at a chair, typing at a computer. From the computer, text reads “it was a dark and stormy night” and from the robot speech bubble we get more binary.
Panel 17: Narration: For example let’s take AI hallucinations. AI Hallucinations refer to when AI makes things up, essentially lying to the user.  Now that we understand how AI works, we can understand how this happens.
Image: The robot is shown its monitor full of a kaleidoscope of colors and two big white eyes. The background behind it is also a mix of colors. 
Panel 18: Narration: AI has no comprehension of lies or the truth. It is regurgitating its training data. Which means that if it doesn't have the answer in the training data, or is fed the wrong answer, what you’re going to get is, the wrong answer.
Panel 19: For example, Google AI made headlines when it recommended people use glue to make the cheese stick on their pizza.  (3). 
Image: A man with dark skin, glasses and a beard stands in front of a pizza and a bottle of glue. He is wearing an apron. 
Man’s speech bubble: “A least it said to use non-toxic glue.
Panel 20: Now where did it get this cooking tip? A joke post from reddit. Google made a deal with Reddit to train it’s A.I on the site’s data in February 2024. 
Image: The avatar for reddit yells after the robot who is running off with the image of a glue bottle on it’s monitor.
Reddit avatar’s speech bubble: It was a joke!
Panel 21: That example was pretty harmless, but it can be much worse. AI has told people to eat poisonous mushrooms (4), provided dieting advice on a hotline for eating disorders (5) or displayed racial bias (6).
Image: The grim reaper is shown, wearing a little shef scarf with his sythe. Next to him is a display of mushrooms. Underneath text reads: guest chef death showcases favorite deadly mushrooms.
Panel 22: Generative AI systems also comes up with fake citations to books and papers that don’t exist. Often is mashes up real authors and journals with fake doi numbers
Image: Three journals are shown composed of fragments of other journals on their covers, each stitched together
Panel 23: Narration: And don’t get me started on the ways images can go wrong (8).
Image: Rebecca stands next to a table with school supplies and a rat. The rat is looking up with her with a question mark over its head.
Rebecca’s speech bubble: Just look up AI rat scandal and you’ll understand why I didn’t draw an example.
Panel 24: Image: The rat from the last panel is shown. 
Rat speech bubble: So AI is worthless? 
Narration: Absolutely not!
Panel 25: 
Narration: AI absolutely has uses. While it’s still in early stages, AI has shown promise in helping doctors identify potentially cancerous moles
Image: The robot and a doctor look at a monitor
Doctor: Should I make a biopsy of both?
Robot: 71%
Doctor: Both it is!

Panel 25: 
Narration: But it’s not a magical solution to every problem. And when we forget that, our “artificial intelligence” is more artificial than anything intelligent.
Image: The robot’s monitor is shown with the citations for this comic displayed.

Comic written and drawn by: Rebecca Kyser

Citations: 

1.Christian B. The Alignment Problem : Machine Learning and Human Values. W.W. Norton & Company; 2021.

2. Lanz D/ JA. AI Kryptonite: Why Artificial Intelligence Can’t Handle Hands. Decrypt. Published April 10, 2023. Accessed August 5, 2024. https://decrypt.co/125865/generative-ai-art-images-hands-fingers-teeth

3. Robison K. Google promised a better search experience — now it’s telling us to put glue on our pizza. The Verge. Published May 23, 2024. Accessed August 5, 2024. https://www.theverge.com/2024/5/23/24162896/google-ai-overview-hallucinations-glue-in-pizza

4. AI-powered mushroom ID apps are frequently wrong - The Washington Post. Accessed August 5, 2024. https://www.washingtonpost.com/technology/2024/03/18/ai-mushroom-id-accuracy/

5. Wells K. An eating disorders chatbot offered dieting advice, raising fears about AI in health. NPR. https://www.npr.org/sections/health-shots/2023/06/08/1180838096/an-eating-disorders-chatbot-offered-dieting-advice-raising-fears-about-ai-in-hea. Published June 9, 2023. Accessed August 5, 2024.

6. Noble SU. Algorithms of Oppression : How Search Engines Reinforce Racism. New York University Press; 2018. doi:10.18574/9781479833641

7. Welborn A. ChatGPT and Fake Citations. Duke University Libraries Blogs. Published March 9, 2023. Accessed August 5, 2024. https://blogs.library.duke.edu/blog/2023/03/09/chatgpt-and-fake-citations/

8. Pearson J. Study Featuring AI-Generated Giant Rat Penis Retracted, Journal Apologizes. Vice. Published February 16, 2024. Accessed August 5, 2024. https://www.vice.com/en/article/4a389b/ai-midjourney-rat-penis-study-retracted-frontiers

9. Lewis. An artificial intelligence tool that can help detect melanoma. MIT News | Massachusetts Institute of Technology. Published April 2, 2021. Accessed August 5, 2024. https://news.mit.edu/2021/artificial-intelligence-tool-can-help-detect-melanoma-0402

Comic books have enjoyed popularity for well over a century, and according to a March 2024 report by the market research firm IBIS World, graphic novels are the most popular product in the $2 billion-a-year comic book publishing sector

Within the graphic novel sector is a subgenre known as Graphic Medicine, a term coined in 2007 by Dr. Ian Williams, a cartoonist and the founder of a website of the same name. Graphic Medicine provides comprehensive information about the genre, including reviews of new publications and podcasts. Since 2010, they have also sponsored an annual conference – the 2024 conference just wrapped in Athlone, Ireland.

Graphic medicine is also a subset of the field of narrative medicine, which centers patient narratives in clinical practice, research, and medical education. One practitioner within this field is Dr. Benjamin Schwartz, who completed his medical training, but is now a cartoonist for the New Yorker, and a professor of narrative medicine at Columbia University. You can read an interview with him at the website, Doctors Who Create. You can view some of Schwartz’s work for the New Yorker here.

Some graphic works in Himmelfarb's collection include: Graphic guide to infectious disease, The Infographic guide to medicine, and Clinical Ethics: A Graphic Medicine Casebook.

Did you know you can also search for graphic medicine in PubMed? A search of the medical subject heading, “Graphic Novels as Topic” will help you find both comics published within journals, as well as articles which, for example, examine the impact of comics on public health.

Himmelfarb’s Reference and Instruction Librarian Rebecca Kyser, herself a cartoonist, suggests the following titles to help you delve into the world of graphic medicine:

Kid Gloves: Nine Months of Careful Chaos, by Lucy Knisley (available to borrow through our local consortium) follows the cartoonist as she goes through the process of trying to become pregnant, being pregnant, and her birth experience. As she chronicles her own experiences with miscarriage, morning sickness, and preeclampsia, Knisley also explores the history of pregnancy, women’s health, myths and superstitions around miscarriage and pregnancy, and the decisions that factor into the choice to have kids in the first place. Entertaining, emotional, and well-researched, this is a great book for anyone, regardless if they plan to have kids, have kids, or never intend to have kids at all.

The Nib (website): The Nib used to be a magazine publisher of anthology comics, usually all revolving around a specific issue, as well as daily comics. While the magazine stopped publishing last year, the entire site is still live for those who wish to buy back issues or view any of the older strips, which sometimes feature medical themes. There’s plenty to check out such as a comic regarding the Covid-19 pandemic’s impact on the Navajo Nation, living with OCD during Covid-19, and the high maternal mortality Black women face.

Comics for Choice, Second Edition  (anthology, currently on New Books Shelf) Published after 2021, this anthology takes a look at the history of abortion in the United States from a range of perspectives. From personal stories about their own abortions to narratives about those who sought to provide access even when the procedure was entirely illegal, this collection showcases the multiple ways reproductive choice and access impact everyone.

Memento Mori by Tiitu Takalo (coming soon to DC Public Library). Takalo, a cartoonist from Finland, tackles her own experience dealing with a cerebral hemorrhage with honesty and a dynamic drawing style. Using color to reflect her own emotions, Takalo takes us through her frightening medical emergency, the monotony of the hospital, and her struggle to access proper health care upon her release. It’s an engaging story bringing to light the reality of an experience most people rarely face themselves

Lighter Than My Shadow by Katie Green (available at DC Public Library). Mental health conditions can be hard to understand, especially given that the symptoms are often internal. By using comics as her medium of choice, Green gives physicality to her own battle with an eating disorder in her teens and college years. Black scribbles follow her from page to page, growing more busy and large as her anorexia worsens. Later, a mouth on her stomach grows and grows as she struggles against the urge to binge food. It’s a difficult read at times – as it should be given what Green was facing – but it explores her own battle with empathy and thoughtfulness.

For a break from studying, or for a way to see the health professions from a different perspective, dive into some graphic medicine!

References

Comic book publishing in the US - market size, industry analysis, trends and forecasts (2024-2029): IBISWorld. IBISWorld Industry Reports. (March 2024). https://www.ibisworld.com/united-states/market-research-reports/comic-book-publishing-industry/#IndustryStatisticsAndTrends Accessed 7/23/2024