Like dissection, but without the mess

One of the newest acquisitions in the Medical Historical Library is in an elegant wooden case, about 3 feet on each side, that opens to reveal a paper model of a 5-foot-9-inch naked man with brown hair, blue eyes, and rosy cheeks. The case is a “deluxe” German edition of White’s Physiological Manikin, a flap anatomy designed by author and publisher James T. White in 1886.

Melissa Grafe, Ph.D., the John R. Bumstead Librarian for Medical History and head of the Medical Historical Library, spotted the manikin, titled Dr. Franke’s Phantom, among the online offerings from a British dealer last October and knew that it belonged in Yale’s collection. The Cushing/Whitney Medical Library already had a strong collection of anatomical books, Grafe said, thanks in large part to library namesake and neurosurgeon Harvey Cushing, M.D., who collected them. But Dr. Franke’s Phantom is not your typical anatomical volume. It’s a flap, or lift-the-flap anatomy, in which each layer of tissue or paper flap can be lifted to reveal the layer underneath. The manikin’s multiple layers of flaps represent muscle, bone, and organs all the way down to the spinal cord. Prior to the new purchase, which arrived at Yale in November 2016, the library had several flap anatomies already, but the new addition is the largest among them. “There’s nothing like this in the collection itself; there’s just nothing to compare,” Grafe said.

According to Grafe, flap anatomies, which date back to the 16th century, gave medical students and interested laypeople a simulation of dissecting a three-dimensional body—without the mess of a cadaver. Dr. Franke’s Phantom, which can hang on the wall, was likely used in its day for traveling lectures, in doctors’ offices, and in anatomy classrooms, Grafe said. “You can just imagine people looking at this—and it’s life-size—walking up to it and being amazed at the complexity of the human body,” Grafe said.

White’s manikin bears a stamp of medical approval from Frank H. Hamilton, M.D., one of four physicians who attended to President James A. Garfield after he was shot in 1881; the name Dr. Franke’s Phantom likely refers to Hamilton, Grafe said. The German edition is considered deluxe, Grafe said, because underneath its male exterior, it contains flaps for both male and female genitalia, plus a womb with a fetus inside. Additional flaps illustrate the positions of hands and forceps during delivery.

Anyone at Yale, as well as outside researchers, can request to use the manikin at the Medical Historical Library. By the end of its first month at Yale, a student had already used the manikin to research a paper about flap anatomies, and Grafe had displayed it for the Society of Clinical Surgery’s 2016 annual meeting at the School of Medicine. “We can envision all kinds of uses for this,” Grafe said.

The manikin is unlikely to appear, however, in the anatomy classroom: Outside the anatomy lab, Yale medical students use a computer resource available at the medical library called VH Dissector Pro, which Grafe describes as “the modern equivalent of lift-the-flap,” which allows students to rotate structures in space. But alongside contemporary tools, flap anatomies retain their places in libraries due to their historical value. They even have an Instagram presence: Look for #flapbookfriday.