Smell is the sense that memoir most likes to supply and least often has the right to. A remembered corridor acquires a smell of disinfectant, a hostel a smell of kerosene and frying onions, an old hospital a smell of paper and dust, and the reader, given a smell, believes at once that the writer was there. Another essay on this site shows how easily a fluent system can invent such a detail and how convincing the invention is. The title of this essay invites exactly that move. It asks for the smell of an old hospital chart, and the honest way to answer is to decline to manufacture one. I studied medicine at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, among paper records, and took my MBBS there in 2002, but I am not going to describe a folder or its odour. I want instead to ask what such a smell is made of, what it does to the person who notices it, and what it cannot tell him.
Those turn out to be three different questions, with answers from three different disciplines. The first belongs to chemistry and to the people who look after libraries. The second belongs to the psychology of memory. The third belongs to anyone who has to decide how much to trust an old document, which includes historians, lawyers and every physician who has opened a thick folder and felt, before reading a line, that a long illness was in his hands.
What the Nose Detects #
In 2009 a group at University College London’s Centre for Sustainable Heritage, led by the chemist Matija Strlič, published a paper with a title that sounds like a joke and is not: “Material degradomics: on the smell of old books.” They took samples of historic paper, collected the volatile compounds the paper gave off, and analysed them. The paper’s odour, they confirmed, is made of the products of its own degradation. Two of these, acetic acid and furfural, were already known as volatile products of decaying paper; the study proposed others, including products of the oxidation of fats. More usefully, the authors showed that the mixture of compounds a sheet gives off could be correlated with properties that matter for its survival: how acidic it is, how much lignin and rosin it contains, and how far the long chains of cellulose that give paper its strength have been broken. The smell, in other words, is a readout. A conservator with the right instrument could judge the condition of a document by sampling the air above it, without touching it.
I find this oddly moving, and also clarifying. The smell that people associate with old books and old records, which they often describe with affection, sometimes with words like vanilla or almond or dust, is the smell of the paper coming apart. It is not the smell of the history the paper holds. It is the smell of the paper’s own illness.
A physician should feel at home with that idea, because medicine used smell as a diagnostic sense long before it had laboratories. The sweetish breath of a person whose diabetes has gone badly out of control is the classic example, still taught: a chemical by-product of a body in trouble, escaping into the air where a trained nose can catch it. The conservator’s nose, or the conservator’s instrument, does the same work for a book. In both cases the odour is a sign, and in both cases the sign concerns the state of the material. The breath tells you about the body’s chemistry today; it does not tell you what the patient has lived through. The smell of old paper tells you about the paper’s chemistry today; it does not tell you whether the notes written on it were careful.
A Medium Chosen for Cheapness #
The Library of Congress publishes a short account of how paper deteriorates, and reading it is a lesson in how much the physical history of a record depends on decisions nobody connected with medicine ever made.
Paper is mostly cellulose, long chains of glucose molecules drawn from the walls of plant cells, and its strength depends largely on how long those chains and fibres remain. Before the middle of the nineteenth century, Western paper was made from cotton and linen rags, by processes that preserved long fibres, and such paper, kept in reasonable conditions, has often lasted for centuries. From the middle of the nineteenth century wood replaced rags. Wood pulp gives shorter fibres; mechanically pulped paper, the kind used for newspapers, retains lignin, which promotes the reactions that break cellulose down. Much wood-pulp paper made before the 1980s was also sized with alum and rosin to keep ink from spreading, and in the presence of moisture that sizing generates sulphuric acid. Acid cuts the cellulose chains; the cutting produces more acid; the process feeds itself, so that the rate of decay increases as the paper ages. The Library’s researchers found that cellulose generates acids of its own within weeks of manufacture, which explains why paper that starts neutral becomes more acidic with time. Pollutants absorbed from the air attack the edges first, which is why the leaves of an old book are often browner and more brittle at the margins than in the middle.
The Library’s summary includes a sentence that every keeper of records should have framed: papers from hundreds of years ago are often still in good condition, while papers from not even thirty years ago are often brittle or even unusable. The difference lies in manufacture, not age. From the 1980s, paper intended to last began to be made with alkaline buffers that neutralise acid, and American standards for permanent paper followed.
Nothing in this history was decided by physicians. The paper on which a hospital’s forms were printed, the card of its folders, the slips on which its laboratory reported, were bought by someone balancing cost against quantity, and nothing in clinical life required them to meet a standard of permanence. A hospital record was meant to be used for years, not centuries, and its paper was chosen accordingly. So the physical history of an illness, in the literal sense, was written on materials whose own history was one of slow chemical self-destruction, at a pace set by pulp, sizing, humidity and the air of the room where the folder was stored. A chart kept in a damp storeroom and a chart kept in a dry one, holding the same entries, would age at different rates, smell different, and look, to a later reader, as though they belonged to different eras.
The Room Inside the Folder #
A record carries its surroundings with it. That is true in a loose, poetic sense, and also in a chemical one, which is the more interesting.
The Library of Congress’s account makes the point that the conditions of storage matter as much as the paper’s manufacture. Moisture drives the reactions that break cellulose down, and warmth speeds them; the Library describes good conditions as cooler temperatures and a relative humidity of thirty to forty percent, in which good paper can last for centuries. Pollutants from the air, chiefly oxides of sulphur and nitrogen, are absorbed at the exposed edges, which is why the margins of an old leaf darken before its centre. The Library also reports that paper bound into books ages faster than loose single sheets, which it attributes to the moisture held within the paper, and that paper kept in an airtight space retains its own acidic products, which then hasten its decline. A tightly packed bundle in a closed cabinet is not necessarily the kindest home for a document, however orderly it looks.
Put those findings beside the climate of a city like Amritsar, with its hot summers and its humid monsoon months, and a general conclusion follows without any need to describe a particular storeroom. Paper records in such a climate, kept without climate control, would have aged faster than identical records in a cool, dry archive. Their edges would have taken up whatever was in the air of the city and the building. A folder that had spent a decade on an open shelf near a corridor would have recorded, in the colour of its margins, something of the room it lived in, and the folder in the next cabinet, closed and crowded, something else. Paper also takes up odours from its surroundings, so that part of what a reader smells in an old record may be the place where it was kept rather than the record itself.
The consequence for a reader is a small but real one. The visible age of a document is not a clock. Two charts of the same year can look a decade apart; a younger chart can look older than an elder one. When a reader judges a page’s age by its colour, or feels the length of an illness in the browning of its sheets, he is reading the storage conditions and the paper’s manufacture at least as much as the calendar. The physical history of an illness, written into the material of its record, is partly the history of a shelf.
Inks That Age Differently #
A chart is a stack of different papers carrying different marks, and each ages in its own way, so that an old folder is less a single object than a set of objects decaying at different speeds.
The ordinary ballpoint pen writes with an ink in which dyes do much of the work, and many dyes fade in light; an entry exposed for years on the top of a pile can grow paler than one protected inside it. Pencil, which is graphite, is chemically stable and physically fragile, surviving well and smudging easily. Carbon copies and the blue impressions of copying paper have their own fading habits. Photocopier toner, fused onto the page, is among the more durable marks a modern office produces. Rubber stamps use inks of variable quality. And then there is thermal paper, on which many machines of the late twentieth century printed their output, from fax machines to the tracings of heart monitors and electrocardiographs. Thermal paper carries no ink at all. Its image is produced by a heat-sensitive coating, and that image can fade with heat, light, contact with some plastics, and time, sometimes until little or nothing remains. Records offices learned to photocopy such pages for that reason.
Earlier centuries had a version of the same problem in a more dramatic form. Iron gall ink, the standard writing ink of Europe for many hundreds of years, is acidic and can, in the wrong conditions, eat through the paper it was written on, so that the letters of an old manuscript survive as holes in the shape of words. It is one of the stranger facts of archival life that the ink can destroy the record it constitutes.
The irony in a modern chart is quieter. Its most mechanical components, the tracings printed by instruments and the faxed reports from other hospitals, which seem the most objective things in the folder, may be among the first to fade. The handwritten notes around them, with all their abbreviations and haste, may outlast them. A reader opening an old folder might find the doctor’s description of an electrocardiogram perfectly legible and the electrocardiogram itself a pale grey ghost on a curling strip. The physical history of an illness is shaped by the chemistry of its documents, and the chemistry does not care which documents mattered.
The Authority of a Smell #
So much for what the smell is. What does it do?
In 2002 Rachel Herz and Jonathan Schooler reported a study designed to test what they called the Proustian hypothesis: the idea, named for the madeleine dipped in tea in In Search of Lost Time, that memories brought back by smells are special. They asked participants to recall personal memories associated with particular objects and then presented each object’s cue as a smell, a picture or a word. Memories recalled in the presence of the odour were rated as significantly more emotional than the same memories recalled with the visual cue or the verbal label, and participants tended to feel more “brought back” to the original event. What such studies show is that a smell intensifies the feeling of a memory. What they do not show is that it makes the memory more accurate. Emotion and vividness are not the same as correctness, and the sense of having been taken back is a sense, not a proof.
An essay on recognition on this site discusses Proust’s distinction between memory summoned and memory that arrives unbidden; I want only to borrow the finding’s warning. Sensory detail lends authority. A smell feels like evidence of having been there, and a reader who is given one, whether by memory or by a writer, tends to stop asking questions about the scene it accompanies. That is why invented smells are the stock-in-trade of false reminiscence, and why I have declined to supply one here.
Something similar happens with old documents, and here the effect is not limited to smell. A folder that is worn, soft at the corners, browned at the edges, faintly fragrant with the slow breakdown of its own paper, carries an aura of authenticity. It looks like a witness. It has the texture of the past, and texture persuades. The essay here on paper’s failures observes that a thick chart persuades by its weight, suggesting a completeness it may not have. Age and wear persuade in the same way, by suggesting a reliability they cannot establish. A well-handled folder may contain a page copied from somewhere else, an undated note, a result filed under the wrong admission, a history repeated for years from a single uncertain source. The handling shows that the folder was used. It says nothing about whether what was written in it was true.
Wear, in other words, is evidence about the object and its handling, not about the record’s contents. It tells you that the folder was opened often, perhaps that the patient was ill for a long time or came back many times. It does not tell you whether the people who opened it read it, whether what they wrote was right, or whether the most important page is the one that is missing. Archivists distinguish between the condition of a document and its provenance, the documented history of where it came from and who has held it. The smell of an old chart speaks only to the first.
Fingerprints #
If smell speaks to the condition of the paper, another physical trace speaks to something else: the hands of readers. In 2010 the art historian Kathryn Rudy published a study of medieval books of hours and prayer books under an irresistible title, “Dirty Books.” Readers of such books, she observed, left fingerprints in the margins, and the darkness of the grime correlates with how intensely a page was handled. She measured it with a densitometer, an instrument that reads the darkness of a reflecting surface, and plotted the results opening by opening. The graphs are a record of reading. In one book the dirt falls away toward the end of a long sequence of devotions, suggesting, she writes, that the owner often fell asleep before reaching compline, the last of the canonical hours. In another, the owner’s fingers darkened the prayers to Saint Sebastian and Saint Adrian, two saints invoked against plague, while the prayer to Saint Apollonia, a few leaves further on, was barely touched. Rudy draws the conclusion with dry economy: the owner apparently did not suffer from toothache but may have had reason to fear the plague.
What makes the study instructive for a reader of old records is what the dirt measures. It says nothing about whether the prayers were well composed or whether they worked. It says where a person’s hands went, and therefore something about what she feared and relied upon. Wear is evidence about readers.
Imagine, purely as a thought experiment, an old inpatient folder held under the same instrument. One would expect the darkest pages to be the ones turned to most often: the sheet of current medicines and orders, the latest results, the most recent progress note, the front sheet with its name and number. One would expect the long admission history, written once and consulted less after the first day, to be comparatively clean, cleanest perhaps in its middle pages. A densitometer would map a ward’s habits of reading, and the map would be useful. It would show which pages were relied upon, and therefore which pages carried the most risk if they were wrong. It would also show which pages almost nobody returned to, and those might include the one that mattered. What it could not show is whether any page was true.
This is the precise sense in which wear is not provenance. A worn folder testifies that it was handled; a darkened page testifies that it was read often. Both are facts about the people who used the record, not about the reliability of what they read. A heavily thumbed medication sheet may carry a transcription error that every reader trusted; a pristine page in the middle of the history may hold the one sentence that would have changed the plan. The physical history of a chart is real, and it is a history of attention, which is a different thing from a history of truth.
The Conservator’s Record #
Conservators, who spend their working lives with aging documents, practise an ethic that a keeper of medical records might envy. When they treat an object, they record its condition before treatment, each intervention they make and the materials they use, and they prefer treatments that can later be undone, so that a successor with better methods can reverse what was done and begin again. The documentation travels with the object as part of its history. A book that has passed through careful hands arrives in the future with an account of what those hands did to it.
Clinical charts rarely received such care, and the result is a peculiar uncertainty about what a surviving chart is. Return to the fading thermal tracing. When a records office photocopied it before the image vanished, which was the record: the original strip, now pale or blank, or the copy, which bears no mark of the machine that made the tracing and often no note of who copied it or when? Folders were split into volumes when they grew too thick, purged of duplicates, rebound, sometimes microfilmed and then destroyed. Each operation was sensible. Few were documented as operations on the record itself. A reader opening such a chart years later handles an object whose physical history has been edited without a trace, and its smell, its wear and its brittle edges tell him only that it is old, not what has been done to it on the way.
The distinction conservators keep, between the history of the information and the history of the object that carries it, seems to me one of the more useful ideas a physician can borrow from them. A chart has both. The first is the familiar question of who wrote what, when, and on what evidence. The second is the question of what has happened to the paper since: what was added, removed, copied, replaced or lost. Paper records kept some evidence of the first and very little of the second, and the sensory richness of an old folder makes it easy to forget that the second history exists at all.
A Robe of Paper #
The Urdu poet Mirza Ghalib, who died in Delhi in 1869, chose to open his collected Urdu ghazals with a couplet about paper, and it has puzzled and delighted readers ever since. In transliteration:
naqsh faryādī hai kis kī shoḳhī-e-taḥrīr kā kāġhazī hai pairahan har paikar-e-taṣvīr kā
Roughly, in my rendering: The image is a plaintiff: against whose playful writing? Of paper is the robe of every figure in the picture.
The gloss usually given for the second line is a custom of old Persia, in which a person seeking redress from the ruler appeared in a garment of paper, so that the clothing itself announced a grievance. Read with that in mind, the couplet says that every figure ever drawn, every created thing, stands dressed as a petitioner, and the first line asks against whose writing the complaint is lodged: the mischievous, playful pen that drew the figure in the first place. Commentators have read the verse as a complaint of creatures against their maker, as a meditation on the transience of things that are only images, and as a statement about poetry itself, whose figures are made of paper and know it. Ghalib was not writing about hospitals. But I know of no line that better describes the person in an old chart.
She is, first, a figure made of paper. In the folder she exists only as she was drawn by the many hands that wrote about her, in their hurry, their abbreviations and their varying attention. Her robe is literally paper, and it is aging, as the chemistry above describes. And she is, second, a petitioner. Every chart begins with a request for help. Before it was a record it was an appeal, made by a person who came to a hospital because something was wrong, and every page that follows is part of the response to that appeal. The paper robe in Ghalib’s couplet signals a grievance; the chart’s paper signals a need. In both cases the clothing is the petition made visible.
Punjabi, which shares the Persian word for paper, ਕਾਗ਼ਜ਼ (kāgaz), gives its adjective a second meaning that sharpens the image. Something ਕਾਗ਼ਜ਼ੀ (kāgzī) is made of paper, and it is also something that exists only on paper: a kāgzī action is a formality, a kāgzī arrangement is nominal, real in the file and nowhere else. The two senses are a quiet warning. A person who exists in a record as a paper figure is always at some risk of becoming a paper fact, someone whose reality is the reality of the file. The faryādī, the plaintiff, is the reminder that she was not. She came with a complaint, in both senses of the word, and the paper is what remains of her asking.
Ghalib’s question, against whose playful writing?, can be turned on the chart too. Another essay here imagines the person who reads a note about herself; a figure who could read her own paper robe might well have a complaint about the writing that drew her. The age and smell of the paper add pathos to that complaint. They do not settle it.
Philiscus, Who Lived by the Wall #
The oldest clinical records to survive in any quantity are the case histories of the Hippocratic Epidemics, written in Greek some twenty-four centuries ago. In Francis Adams’s Victorian translation the first of a series of fourteen cases begins: “Philiscus, who lived by the Wall, took to bed on the first day of acute fever.” The record follows him day by day: sweating and an uneasy night; the symptoms worse on the second day; a morning free of fever on the third and an acute fever by evening, with thirst and black urine and delirium; a trickle of blood from the nose on the fifth; cold extremities, loss of speech, and then the clause “about the middle of the sixth day he died.” A last sentence notes that his breathing was rare and large throughout and that “the paroxysms” came “on the even days.” The second case is “Silenus,” who “lived on the Broad-way, near the house of Evalcidas.”
That is all anyone will ever know of them. Sir Thomas Browne, the seventeenth-century physician of Norwich whose meditation on the anonymous dead another essay here reads closely, had such patients in mind when he asked, in Hydriotaphia in 1658, who would care to subsist “like Hippocrates’s patients” under “naked nominations”: as names without deeds. The phrase is exact. Philiscus survives as a name, a street, a fever and a death, and he survives because his physician wrote him down and because the writings were copied, century after century, by people interested in the physician and not in him.
Notice what the record chose to keep. It counts days, because the Hippocratic physicians believed that fevers moved toward crises on particular days, and the observation that his paroxysms came on even days mattered to that belief. It describes urine, stools, sweat and sleep, because those were the signs the theory read. It does not say how old he was, what he did for a living, who sat with him, whether he was afraid, or what he said in his delirium. A record keeps what its writer’s medicine needs. Every chart is shaped this way, by the questions the medicine of its day thought worth asking, and an old chart preserves, along with its patient, the theory of the people who wrote it. The yellowing of the paper adds age to that theory. It does not add authority.
The survival of Philiscus also illustrates a law that every archive obeys: what lasts does so by accident more than by merit. He is remembered because one physician’s notes were copied; his neighbours, whose illnesses may have been more instructive, are gone. Medical archives work the same way. The records that survive are not the most important or the most careful. They are the ones that happened to be kept, by an institution with space, by a regulation that required retention for a period, by a family that put a folder in a trunk, by a historian who rescued a run of casebooks. California’s hospital regulations, for instance, require patient records to be preserved for at least seven years after discharge, longer for minors; after that, their survival is a matter of policy and storage. Most clinical records of the paper era, everywhere, were eventually destroyed, and their destruction was proper. A hospital that kept every page forever would be a warehouse, and its patients’ privacy would last only as long as its locks. The records that remain are a sample shaped by chance, and a reader of an old chart should remember that he is holding a survivor, not a representative.
What the Paper Leaves Out #
A sensory image of an old chart, the browned edges, the soft card, the faint sweetness of decaying cellulose, gives the impression that something substantial has been preserved. In one sense it has. In another, the image hides how much was never in the folder at all.
It never held the patient’s own account in her own words, except as others summarised it. It never held what was said at the bedside at night and not written down, or what a relative explained in the corridor, or what the patient decided at home about the medicines she had been given. It held the hospital’s encounters with her and nothing of the long stretches of her illness that happened elsewhere. It held nothing from the other hospitals she visited, whose folders were in their own storerooms aging at their own rates. And it held nothing of the many things that were done and not recorded because there was no time, or because nobody thought them worth the ink.
These absences are not faults of paper particularly; every record has them. But a tangible, aged, fragrant object makes them harder to feel. A screen showing a partial record looks partial, or at least it looks like a screen. A folder that has visibly lived for years looks like a life. The reader holding it is tempted to believe that the illness is in his hands, when what is in his hands is the part of the illness that passed through one institution’s paperwork and then survived its storeroom.
Affection With a Boundary #
I do not want to argue anyone out of affection for old paper. There is real pleasure in a material record: in handwriting that changes from entry to entry, in a document that shows its age honestly, in an object one can hold. The pleasure belongs to a long human relationship with written things, and a profession that spent most of its history writing on paper is entitled to some tenderness toward it.
But affection needs a boundary, and the boundary is the one the chemistry draws. The smell is decay. The paper that holds it is destroying itself, at a rate set by its manufacture and its storage, and whatever is written on it will eventually go with it unless someone copies it to something else. A medium that is quietly consuming its own contents is a poor thing to be nostalgic about as a medium, however lovely it is as an object. And the practical problems of paper as an archive were never small: the space it occupies, the damp that hastens its decay, its vulnerability to fire and water and insects, the impossibility of finding one page among a million without someone who knows the shelves, the ease with which a folder can be read by anyone who picks it up. A fondness for the smell of an old chart is a fondness for a sensation. It should not become an argument about how records ought to be kept.
A Person Beyond the Folder #
What, finally, does the smell of an old hospital chart tell a reader? It tells him that the paper is old and degrading, and roughly how degraded it is. The wear around it tells him something about the people who read it, where their fingers went and what they relied upon. Its survival at all tells him something about the accidents of storage and policy. And the smell may move him, by the peculiar power smells have over memory, to feel more strongly about what he is reading. None of it tells him whether what he is reading is true, complete or fair to the person it describes.
That person is the one thing the folder cannot contain. Ghalib’s figure wears paper and petitions against the hand that drew her; Philiscus survives as a name by the Wall and a fever counted in days. In both cases the paper is what is left, and in both the paper is not the person. The patient whose care produced a chart had a life before she arrived at the hospital and, very often, a long life after she left it, and most of that life was never written down by anyone. Some of it should never be. A record that preserved everything would be a violation, and much of what a chart leaves out is left out properly, because it belonged to her and not to the hospital.
If I were to keep one habit from the material world of paper, then, it would not be a fondness for its smell. It would be the habit of asking, whenever a record feels authentic, what exactly is producing the feeling. Sometimes it is the chemistry of cellulose; sometimes the grime of other people’s attention; sometimes the authority of an old hand or the weight of a thick spine. The feeling is real, and it is a feeling about the object. The illness the object records happened to someone who was never made of paper, and whatever became of her happened where the folder could not follow.
Evidence and Editorial Note #
Documented findings. Public biography relied on: medical studies at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, among predominantly paper records, MBBS 2002. Strlič M, Thomas J, Trafela T and colleagues, “Material degradomics: on the smell of old books,” Analytical Chemistry 2009;81:8617–8622 (PubMed abstract, PMID 19761214): volatile degradation products constituting the smell of old books; acetic acid and furfural as known products; lipid peroxidation products proposed; correlation with rosin, lignin, carbonyl content, degree of polymerisation of cellulose and acidity; non-destructive identification of degraded objects. Library of Congress, “The Deterioration and Preservation of Paper: Some Essential Facts” (https://www.loc.gov/preservation/care/deterioratebrochure.html): cellulose; rag paper before the mid-nineteenth century; wood pulp, lignin and mechanical pulping; alum-rosin sizing generating sulphuric acid in wood-pulp paper before the 1980s; self-feeding acid hydrolysis; acids generated by cellulose within weeks; pollutants absorbed at the edges; storage in cool conditions at 30–40 percent relative humidity; faster ageing of bound paper and of paper in airtight enclosures; old papers in good condition versus papers under thirty years old that are brittle; alkaline buffering from the 1980s and ANSI/NISO Z39.48-1992. Herz RS, Schooler JW, “A naturalistic study of autobiographical memories evoked by olfactory and visual cues: testing the Proustian hypothesis,” American Journal of Psychology 2002;115:21–32 (PubMed abstract, PMID 11868193): odour-evoked memories more emotional and more “brought back” than visually or verbally cued ones. Rudy KM, “Dirty Books: Quantifying Patterns of Use in Medieval Manuscripts Using a Densitometer,” Journal of Historians of Netherlandish Art 2010;2(1–2), DOI 10.5092/jhna.2010.2.1.1 (jhna.org article text): fingerprints and grime as evidence of handling, densitometry, the drop-off before compline, the worn suffrages to Saints Sebastian and Adrian against the barely touched suffrage to Saint Apollonia, and the author’s inference about plague and toothache. Hippocrates, Epidemics I, cases I and II, in Francis Adams’s translation, The Genuine Works of Hippocrates (1849), quoted from the Project Gutenberg text. Sir Thomas Browne, Hydriotaphia, Urn Burial (1658), chapter 5, “Hippocrates’s patients” and “naked nominations,” quoted from the Project Gutenberg text (Religio Medici, Hydriotaphia, and the Letter to a Friend); Browne is read more fully in the linked essay on the first cadaver. California Code of Regulations, Title 22, § 70751(c) (Cornell Legal Information Institute text): retention for a minimum of seven years after discharge, with the rule for unemancipated minors. Mirza Ghalib’s opening couplet of the Urdu divan, given in transliteration with the author’s own rendering; the gloss on petitioners in paper garments in old Persia and the range of commentary on the verse: standard reference knowledge. ਕਾਗ਼ਜ਼ and ਕਾਗ਼ਜ਼ੀ in Punjabi usage, including the sense “only on paper”: standard reference knowledge of the language. Dye-based ballpoint inks fading in light; the stability of graphite and fused toner; thermal paper’s heat-sensitive coating and fading and its use in fax machines and instrument printers; the photocopying, microfilming and purging of clinical records; iron gall ink corrosion; the absorption of ambient odours by paper; Amritsar’s hot summers and humid monsoon; the clinical use of smell; and the conservation practices of documenting condition and treatment and preferring reversible interventions, with the archival distinction between condition and provenance: standard reference knowledge, stated in general terms. Vendor representations. None.
Recollection and tradition. The author’s training place and dates are his published biography. No chart, folder, storeroom, smell, ward or patient is recalled, and no sensory experience is attributed to the author; the essay deliberately declines to describe a remembered odour. The densitometer applied to an inpatient folder is a thought experiment, introduced as such. Statements about hospital stationery, storage and climate are general and make no claim about Sri Guru Ram Das Institute or any other particular hospital.
Analysis and forecast. The reading of the smell of old paper as a sign of the paper’s own decay, the analogy with clinical smell, the argument that odour, colour and wear lend authority without establishing provenance or completeness, the application of Rudy’s method to clinical folders, the distinction between the history of the information and the history of the object, the readings of Ghalib’s couplet and of the Hippocratic case histories and Browne’s phrase, the account of archival survival by accident, and the boundary drawn around nostalgia are the author’s interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.