Journal Offers Dose of Fun for Holiday

LONDON — Dutch and Norwegian scientists say they have solved a glowing mystery: why Rudolph the reindeer’s nose is red.

By traveling to the Arctic and using video-microscope and thermal imaging technology, the scientists showed that the glow is from tiny blood vessels that are more abundant in the noses of reindeer than in humans’. Yes, seriously. The findings are being reported next week in BMJ, formerly known as The British Medical Journal, a publication with a quirky holiday tradition. 

For the past 30 years, BMJ has devoted its Christmas-week issue to a lighter and sometimes brighter side of medicine, publishing unusual articles that vary from simply amusing to bizarre to creative or potentially important. All are based on methodologically sound science.

Alongside Rudolph on the cover of this year’s holiday issue is Cliff, a 2-year-old beagle who was trained by another Dutch team to accurately sniff out the sometimes fatal bacterial bowel infection Clostridium difficile and make the diagnosis in minutes — days faster than standard laboratory tests. The Christmas tradition began in 1982, originally intended as a one-time effort to give readers a break from stodgy scientific reports written in technical jargon. The editor then, Dr. Stephen P. Lock, recalled in an interview that he wanted to present “another side of medicine” by offering lighter reading: research oddities, bizarre stories and history. But this was no April fools’ issue: Dr. Lock insisted that the articles meet the same rigorous criteria as research published in regular issues. 

Indeed, some articles in the holiday issue are also suitable for regular issues, said Dr. Tony Delamothe, the BMJ deputy editor who has overseen the last eight Christmas issues. “We are on an incessant search for novelty,” he said.

Over the years, BMJ Christmas reports have demolished myths, including a Danish one that people could get drunk by absorbing alcohol through the feet. After soaking their feet for three hours in a basin containing three bottles of vodka and measuring their blood alcohol levels, three Danish scientists found no such absorption. 

The first Christmas issue included an account of a resuscitation from 1650 that still astounds today. An unwed 22-year-old mother in Oxford was condemned to death after being accused of murdering her premature, stillborn son and concealing his body. She was executed by hanging by the neck for half an hour while people present jerked her up and down.

At the time, the bodies of executed prisoners were given to doctors for anatomical dissection. Two doctors who opened the woman’s coffin were startled to hear raspy breaths. They revived her, and she went on to recover her memory and live another 15 years, marrying and giving birth to three children. The 17th-century doctors’ report met the criteria for a modern case report, wrote J. Trevor Hughes, the author of the 1982 article. 

Dr. Lock, the editor, also encouraged historical back stories. In 1984, Dr. Charles Fletcher wrote about how he tested ways to safely administer the first precious batches of penicillin in 1941. The initial full test was on a 43-year-old British policeman who developed the widespread bacterial infection septicemia. He showed striking improvement from small doses of the antibiotic, but he died after the scarce supply — much of it recycled from his urine — ran out.

Many Christmas issue accounts would have upset earlier BMJ editors “like mad,” Dr. Lock said. “But so what?” he added. “It was fun.” Now there is so much competition for a spot in the issue that some authors submit papers early in the year and request publication at Christmastime. 

Some articles poke fun at hoary traditions, such as diagnosing ailments in historical figures despite the lack of medical evidence. Mozart is a special favorite of armchair diagnosticians, Dr. Lucien R. Karhausen wrote in 2010 after tabulating articles reporting 140 possible causes of death and 27 mental disorders in the composer. Many, he said, were based on shoddy medical interpretations, undocumented “eyewitness accounts” or the ignoring of criteria that separate normal and abnormal behavior.

“Some causes are plausible,” Dr. Karhausen wrote, “only a few — maybe one, or maybe none of them — can be true, so most if not all are false.” 

In 2006, BMJ reported on the results of a questionnaire sent to 110 members of the Sword Swallowers’ Association International. Forty-six members responded; they reported having swallowed more than 2,000 swords in the three preceding months. Sore throats (“sword throats”) were common during the learning phase, and after frequent repeated performances. Swallowers rarely sought medical advice. Of six who perforated their pharynx or esophagus, three needed surgery. No deaths were reported.

Still other articles play on the vanity of doctors, many of whose names are attached to instruments and syndromes. An article in 2010 extended the list to food products developed by doctors, including Kellogg’s Corn Flakes, various cookies, and Penfolds and Lindeman’s, the Australian wines. 

As for the animals featured in this year’s holiday issue: The story of the infection-sniffing beagle began with a report from a nurse in the Netherlands, who mentioned that a patient’s stool had the distinctive odor of C. difficile — a bacterium that is causing serious and growing public-health problems in many countries, including the United States.

A team led by Dr. Marije K. Bomers at the VU University Medical Center in Amsterdam reasoned that it might be possible to train dogs to detect the infection, and Cliff the beagle did just that. 

Cliff was trained to sit or lie down when he smelled C. difficile in the air walking by a patient’s bedside, and he also quickly and accurately identified all 50 stool samples with C. difficile and 25 of 30 infected patients — along with 50 stool samples free of the bacteria and 265 of 270 uninfected patients.

And the Dutch team that studied reindeer, working with researchers at the University of Tromso in the Norwegian Arctic, used a hand-held video microscope to observe the deer’s nasal capillaries as they ran on a treadmill. 

The capillaries are arranged in circular clusters at different locations through the nose. Those in reindeer noses are 25 percent thicker than those observed in the human nose and are believed to perform critical roles like heating, delivering oxygen and humidifying inhaled air to keep the animal’s nose from freezing. (The leader of the team, Can Ince, a physiologist at Erasmus University Medical Center in Rotterdam, says he has a financial interest in the company that manufactures the technology, which is used to monitor reactions to various drugs and therapies among critically ill human patients.)

By showing that a large number of red blood cells flowed through the small nasal vessels, the scientists said they had unlocked the mystery of Rudolph’s red nose. May it long glow. 

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In Gun Debate, a Misguided Focus on Mental Illness

In the wake of the terrible shooting at an elementary school in Newtown, Conn., national attention has turned again to the complex links between violence, mental illness and gun control. 

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mentally illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force. 

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Children Can Usually Recover From Emotional Trauma

On April 20, 1999, Crystal Woodman, 16, was studying for a test in the library at Columbine High School when Dylan Klebold and Eric Harris walked in and began shooting. For seven and a half minutes she hid beneath a table listening to screams, gunfire and the two teenagers’ laughter.

“I thought, ‘I’m not going to live through this,’ ” said the young woman, now Crystal Woodman Miller, in a telephone interview this weekend from her home in Morrison, Colo., 15 miles from Columbine. “I’m 16 and I’m facing the reality of my death.” 

When the two gunmen left the library to get more ammunition, she managed to escape without physical injury.

But the emotional aftermath was debilitating. 

“I experienced nightmares all night, every night for two years,” said Mrs. Miller, now 30. “I was living in a paradox: I wanted to be around people, but I didn’t want people around me.”

Like many trauma victims, she found herself searching for exits and formulating an escape plan every time she entered a room. A friend followed her around with a box of Girl Scout cookies to make sure she ate something. 

For young people exposed to gun trauma — like the students of Sandy Hook Elementary School in Newtown, Conn. — the road to recovery can be long and torturous, marked by anxiety, nightmares, school trouble and even substance abuse. Witnessing lethal violence ruptures a child’s sense of security, psychiatrists say, leaving behind an array of emotional and social challenges that are not easily resolved.

But the good news is that most of these children will probably heal. 

“Most kids, even of this age, are resilient,” said Dr. Glenn Saxe, chairman of child and adolescent psychiatry at NYU Langone Medical Center. “The data shows that the majority of people after a trauma, including a school assault, will end up doing O.K.”

In a 2007 Duke University study that psychiatrists say is nationally representative, only 13 percent of people who had experienced a traumatic event before age 16 developed symptoms associated with post-traumatic stress disorder, and less than 1 percent developed “full-blown” PTSD. Over all, more than two-thirds of the 1,420 children surveyed reported experiencing some kind of trauma. 

“Like recovering from surgery, you could end up with a scar, and depending on the surgery it could be a big one,” said Dr. Don Bechtold, medical director of the Jefferson Center for Mental Health in Wheat Ridge, Colo. “People get better — the extent of what ‘better’ means is relative.”

Today, Mrs. Miller describes herself as a happy, well-adjusted wife and mother, free of the nightmares and depression that haunted her in the months after the shooting. “I’ll never be the same,” she said, “but I eventually realized I can choose to be bitter, angry and hateful or I can choose to forgive and to live my life despite what has happened.” 

The factors that determine how well a child may recover after a trauma run a gamut from personal to environmental. To what extent was the child exposed to the event? Did he actually see a shooting, or hear one? In the Duke study, children were more likely to develop long-term problems if they experienced multiple traumas.

Psychiatrists say a supportive family helps. And natural resilience — people’s likelihood to process their feelings verbally or have a positive attitude toward their future — plays a role, too. 

And while the tender age of the Newtown schoolchildren has yielded speculation that they could be more deeply or irreversibly scarred, research does not bear out the theory, Dr. Saxe says.

“There is no compelling data I know that says there is a greater risk depending on whether the child is younger or older,” he said. “It really depends on the individual. You have to look at the whole host of risk factors.” 

That is not to say a kindergartner will process trauma in the same way as a teenager. “A 5-year-old isn’t likely to talk about it, and certainly not in an adult way,” said Dr. Bechtold, who was part of the initial mental health response team for the Columbine shootings. Preschoolers are “more likely to be fearful, to ask a lot of questions and ask whether they’re safe; they may become clingy or have separation problems.”

Young children exposed to trauma often regress, returning to whiny baby talk or self-soothing habits they had outgrown, like carrying a favorite blanket. 

One reason people tend to overestimate the psychological damage a child may sustain after a school shooting is that they underestimate the prevalence of childhood trauma. In a 1997 study of 12-to-17-year-olds conducted by the Medical University of South Carolina, 8 percent reported experiencing a sexual assault, 17 percent reported physical assault and 39 percent said they had been witness to violence.

“In a way, trauma is part of the ticket of being human,” Dr. Saxe said. “Most of us can look back and note at least one experience where there was a pretty big threat” to our safety. “Most people use that, manage and cope and go on.” 

But the effects of PTSD linger over some families for years.

Marjorie Long, a sophomore at Columbine in 1999, was trapped for hours in a classroom with a dying teacher. Her mother, Peggy Lindholm, responding to an interview request made to Ms. Long, said that news of mass shootings still had the power to shut her daughter down. “She’s really taking this one hard,” she said. 

Because Ms. Long couldn’t bear to be in a classroom, she eventually dropped out of high school. She battled illness, nightmares and addiction. “She was physically sick for a year,” said Ms. Lindholm, whose own divorce soon followed.

Today, Ms. Long, 30, is married, sober and working toward a graduate degree. But she still has trouble with loud noises. 

“Fourth of July really bothers her,” Ms. Lindholm said, “and that used to be one of her favorites.” And she still runs the risk of reliving her experience every time something triggers it. “Now she’ll shut down for the next month.”

For others, leaving it behind is easier. Mrs. Miller, the student who hid under the table in the library, says she can’t put her finger on the day she started feeling better. But like the pain from a bitter breakup, her anxiety and nightmares gradually eased — probably, she says, as a result of time, regular therapy and travel. (She has spent much of the past 13 years speaking and volunteering in countries affected by adversity, like Kosovo and Indonesia, after the 2004 tsunami.) 

On Saturday, having closely followed the news in Newtown, Mrs. Miller said she was deeply saddened, but not depressed or unable to function.

“The shootings in Aurora, this, it doesn’t send me back to reliving it,” she said. “What I feel is an overwhelming sense of grief and sadness for the community and the survivors. But I’m not traumatized.” 

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Ancient Bones That Tell a Story of Compassion

While it is a painful truism that brutality and violence are at least as old as humanity, so, it seems, is caring for the sick and disabled.

And some archaeologists are suggesting a closer, more systematic look at how prehistoric people — who may have left only their bones — treated illness, injury and incapacitation. Call it the archaeology of health care. 

The case that led Lorna Tilley and Marc Oxenham of Australian National University in Canberra to this idea is that of a profoundly ill young man who lived 4,000 years ago in what is now northern Vietnam and was buried, as were others in his culture, at a site known as Man Bac.

Almost all the other skeletons at the site, south of Hanoi and about 15 miles from the coast, lie straight. Burial 9, as both the remains and the once living person are known, was laid to rest curled in the fetal position. When Ms. Tilley, a graduate student in archaeology, and Dr. Oxenham, a professor, excavated and examined the skeleton in 2007 it became clear why. His fused vertebrae, weak bones and other evidence suggested that he lies in death as he did in life, bent and crippled by disease. 

They gathered that he became paralyzed from the waist down before adolescence, the result of a congenital disease known as Klippel-Feil syndrome. He had little, if any, use of his arms and could not have fed himself or kept himself clean. But he lived another 10 years or so.

 They concluded that the people around him who had no metal and lived by fishing, hunting and raising barely domesticated pigs, took the time and care to tend to his every need.

“There’s an emotional experience in excavating any human being, a feeling of awe,” Ms. Tilley said, and a responsibility “to tell the story with as much accuracy and humanity as we can.” 

This case, and other similar, if less extreme examples of illness and disability, have prompted Ms. Tilley and Dr. Oxenham to ask what the dimensions of such a story are, what care for the sick and injured says about the culture that provided it.

The archaeologists described the extent of Burial 9’s disability in a paper in Anthropological Science in 2009. Two years later, they returned to the case to address the issue of health care head on. “The provision and receipt of health care may therefore reflect some of the most fundamental aspects of a culture,” the two archaeologists wrote in The International Journal of Paleopathology

And earlier this year, in proposing what she calls a “bioarchaeology of care,” Ms. Tilley wrote that this field of study “has the potential to provide important — and possibly unique — insights into the lives of those under study.” In the case of Burial 9, she says, not only does his care indicate tolerance and cooperation in his culture, but suggests that he himself had a sense of his own worth and a strong will to live. Without that, she says, he could not have stayed alive.

“I’m obviously not the first archaeologist” to notice evidence of people who needed help to survive in stone age or other early cultures, she said. Nor does her method “come out of the blue.” It is based on and extends previous work.

Among archaeological finds, she said, she knows “about 30 cases in which the disease or pathology was so severe, they must have had care in order to survive.” And she said there are certainly more such cases to be described. “I am totally confident that there are almost any number of case studies where direct support or accommodation was necessary.”

Such cases include at least one Neanderthal, Shanidar 1, from a site in Iraq, dating to 45,000 years ago, who died around age 50 with one arm amputated, loss of vision in one eye and other injuries. Another is Windover boy from about 7,500 years ago, found in Florida, who had a severe congenital spinal malformation known as spina bifida, and lived to around age 15. D. N. Dickel and G. H. Doran, from Florida State University wrote the original paper on the case in 1989, and they concluded that contrary to popular stereotypes of prehistoric people, “under some conditions life 7,500 years ago included an ability and willingness to help and sustain the chronically ill and handicapped.” . 

In another well-known case, the skeleton of a teenage boy, Romito 2, found at a site in Italy in the 1980s, and dating to 10,000 years ago, showed a form of severe dwarfism that left the boy with very short arms. His people were nomadic and they lived by hunting and gathering. He didn’t need nursing care, but the group would have had to accept that he couldn’t run at the same pace or participate in hunting in the same way others did.

Ms. Tilley gained her undergraduate degree in psychology in 1982 and worked in the health care industry studying treatment outcomes before coming to the study of archaeology. She said her experience influenced her interest in ancient health care. 

What she proposes, in papers with Dr. Oxenham and in a dissertation in progress, is a standard four-stage method for studying ancient remains of disabled or ill individuals with an eye to understanding their societies. She sets up several stages of investigation: first, establishing what was wrong with a person; second, describing the impact of the illness or disability given the way of life followed in that culture; and third, concluding what level of care would have needed.

A paralyzed person, for example, would need “direct support” similar to nursing care while someone like Romito 2 would need “accommodation,” that is to say tolerance of his limitations and some assistance. 

Debra L. Martin, associate professor of biological anthropology at the University of Nevada, Las Vegas, invited Ms. Tilley to write “The Bioarchaeology of Care” for a special report on new directions in bioarchaeology published this year in the Archaeological Record, the magazine of the Society for American Archaeology.

She said in an e-mail that what Ms. Tilley proposes “is a very nicely integrated approach” to using all the available evidence. “Lorna’s innovative approach,” she said, “has provided a way to move from the bones of individuals to thinking about the community as a whole.” 

The fourth stage in the proposed method is where the gathered facts form the basis for interpretation. Extrapolating from hard evidence drawn from human remains to conclusions about how people lived is at the heart of bioarchaeology, a word coined in the 1970s by Jane E. Buikstra at Arizona State University to describe using the methods of physical anthropology, which concentrates on the bones, and those of archaeology, which concentrates on the culture and its artifacts, to try to “people the past,” as she phrases it, to put ancient people into a cultural context.

Dr. Buikstra, director of the Center for Bioarchaeological Research, who currently concentrates on the co-evolution of humans and their diseases, said that “People have from time to time across the years tried to attribute caring and caring for” to ancient humans. But, she said, “getting into the minds of ancient people” is always difficult. Ms. Tilley’s methods for how and when to make that kind of leap would base such attempts on standards used today for evaluating health care needs for severely disabled people.

Dr. Martin, who studies violence and illness as well, gave an example from her own work of the sort of case that can benefit from Ms. Tilley’s approach. The case is described in a coming book, “The Bioarchaeology of Individuals.” A skeleton of a young woman about 18 years old from a site on the Arabian Peninsula more than 4,000 years old indicated that the woman had a neuromuscular disease, perhaps polio.

“Her condition likely made it difficult for her to walk,” Dr. Martin wrote in an e-mail. “She had exceedingly thin arm and leg bones with very little buildup of normal muscle attachments.” She probably received round-the-clock care, Dr. Martin concluded. 

But one problem that she had was apparently not a result of the disease. The teeth that she had were full of cavities, and she was “missing teeth from abscesses and periodontal disease.”

Those who cared for the young woman may have been too kind, Dr. Martin said. Her people grew dates, and, “Perhaps to make her happy, they fed her a lot of sticky, gummy dates, which eventually just rotted her teeth out, unusual for someone so young.” 

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In Island’s Shifted Sands, Signs of a Hurricane’s Power

Starting at the water’s edge, B. J. Reynolds had rolled his surveying pole about 200 feet inland across the beach, the GPS receiver on top producing continuous elevation data that was recorded in a computer in his backpack.

Now Mr. Reynolds, a technician with the United States Geological Survey, had reached the line of dunes that runs the length of the 31-mile barrier island. To complete the elevation profile of this slice of the beach-dune system, he needed to run the equipment to the top. 

“When we came out here before the storm, we could walk right up the dune,” Mr. Reynolds said. But that storm — Hurricane Sandy — had obliterated much of the dune, leaving a steep scarp face about 12 feet high. So a colleague from the National Park Service, Jordan Raphael, scrambled to the top, threw down a rope and hauled the pole and backpack up, taking the final measurements.

The work — in all, Mr. Reynolds and Mr. Raphael took about 10 profiles at intervals along the island on two brisk and sparkling days last week — is part of an effort by scientists to take advantage of a storm like no other in recent memory to learn more about how Fire Island, and all barrier islands, respond to and recover from major natural events. 

“We have the experiment of a lifetime sitting in our laps,” said Cheryl J. Hapke, a geological survey scientist who has studied Fire Island since 2006.

Already, Dr. Hapke and others have learned a lot about how the narrow island behaved during the storm — pretty much as expected, they say. And in the seven weeks since the storm they are already seeing signs of natural recovery, as waves remold the beaches and windblown sand builds up at the foot of the dune scarps. 

What the scientists learn will help government agencies, including the Army Corps of Engineers, in their lengthy effort to determine how best to maintain parts of Fire Island, to protect the private vacation communities on its western half, which were hit hard by Hurricane Sandy, and to ensure that the island continues to do what it did during the storm — safeguard the Long Island mainland a few miles north across the Great South Bay.

“Barrier islands are supposed to take the brunt of storms,” said Chris Soller, superintendent of the Fire Island National Seashore. “And Fire Island did that.” 

Dr. Hapke, a geologist, will be analyzing the latest elevation profiles, comparing them with ones taken on Oct. 28, just before the storm hit, and at various times since, and other data, including aerial surveys of the island made using laser range-finding equipment called lidar. (The geological survey is currently analyzing lidar data for New Jersey and other affected coastal areas as well.)

For Dr. Hapke, the data, and her trained eyes, already are telling her that the storm wrought major changes. 

“Sandy completely flattened this beach,” she said, looking around as the survey team took a break at this pristine spot in the national seashore east of Davis Beach, one of the worst hit communities. The beach is now about eight feet lower, an elevation loss that is typical.

The scarped dunes extend as far as the eye can see up and down the island. In many places 50 feet or more of dune are gone, exposing heavier and redder garnet sand that separated into layers over time since being deposited as glacial ice retreated thousands of years ago. 

At many low spots along the dunes, the surge from the storm completely overtopped them. In three locations on the eastern half, the surging waters carved new channels, breaches that allow water to flow between the ocean and bay. At other locations the island remained intact but the waters pushed enormous amounts of sand inland, raising elevations on the bay side.

Overall, Mr. Soller said, the storm shifted so much sand inland that Fire Island probably migrated north, toward the mainland, by about 65 to 85 feet. 

“This was an amazingly powerful storm that reshaped the island dramatically and moved it,” he said.

But such migration was not unexpected. “Storms are the driver” that shape and move barrier islands, Dr. Hapke said. 

Many factors influenced how Hurricane Sandy altered the island, including its size, strength, track and duration, the height and timing of tides, and the height and composition of the dunes. Although beaches and dunes across the island lost about two-thirds of their sand in the storm, Dr. Hapke said, the losses were greater in some of the developed areas, where homes that once were sitting atop dunes on timber piles now seem stranded in midair.

These areas may have lost more sand because they had more to lose — their beaches and dunes were replenished three years ago, by pumping sand from offshore. But another reason, Dr. Hapke suggested, may be that natural dunes, which become well consolidated as they slowly build over time, are better able to withstand erosion than dunes that consist largely of bulldozed sand. 

Underwater features just offshore also played a role in determining the storm’s impact, increasing or reducing the wave energy reaching the island. “The pattern of the response to storms is directly linked to geology,” Dr. Hapke said.

In fact, she said, Fire Island is in some ways a creature of offshore conditions that create disparities between the western and eastern halves. 

Just offshore near the island’s midpoint, she said, is a huge delta of rock and sand that washed out of the glaciers thousands of years ago. West of this delta lies a series of undersea ridges of sand, which may have come from the glacial outwash.

The western half of the island has never had a shortage of sand — research shows it has gained elevation in the last 500 to 1,000 years — and the undersea ridges may be the source. The ridges also reduce some of the energy hitting the shoreline; there is no historical record, for instance, of a breach ever occurring in the western half. 

But the eastern half has no such sand supply, and the nearby seafloor is relatively deep and flat. “A lot higher wave energy reaches the coastline on the eastern side,” Dr. Hapke said.

In its long-term planning for the island, which calls for replenishing beaches and dunes to protect developed areas, the Army Corps has identified the offshore sandy ridges as potential sources of sand, or “borrow” areas. But Dr. Hapke said that taking sand from these areas might reduce the amount available naturally to the island, and changing the underwater landscape might affect the power of future storms. “If you mine too much sand, you alter the wave action,” she said. 

Christopher Gardner, a spokesman for the New York district of the Army Corps, said that “there’s a lot that goes into the selection process for borrow areas.” The plan, called the Fire Island to Montauk Point Reformulation Study, is still being prepared.

Regardless of what people do, the island will continue to reshape itself. Barrier islands are dynamic places, and post-storm, waves and wind have already been at work.

Two of the breaches were closed by the Army Corps, but the third, near a place called Old Inlet, is being left open for up to 60 days and monitored. Breaches are a concern because they may raise water levels in the bay, which could worsen mainland flooding in the event of another storm. But breaches, at least temporary ones, can also provide benefits by flushing stagnant water from the bay. 

Last week, as water rushed through the 100-yard-wide channel, there were signs that the breach might be closing on its own, as sand was building up from east to west on the ocean side. Scientists and officials from the various agencies involved will meet before the end of the year to decide how to proceed.

The beaches are evolving; sandbars appeared along some stretches in the days immediately following the storm as the seas calmed, and waves are currently fighting to reclaim them. But the island’s northward migration is permanent; the beaches and dunes may at some point resemble how they looked before the storm, but they will not be in the same place. 

“As much as everyone would like it to be exactly as it was, what we’re going to have is a different Fire Island,” Mr. Soller said. “That’s the reality.”

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