Vedder found the medical book at a garage sale. Ament stated, "Ed brought in that book, and we said man that would make a great album cover." He explained that from "Vs." onward the band tried to take different approaches to packaging its records. Ament said, "We tried really hard, to make it like a book, kind of tipped it so it opened horizontally, which pissed off record stores: they had to put it in sideways." The packaging cost an extra 50 cents per copy. Problems arose when the band discovered that later versions of the book were still under copyright. The band had to confer with their lawyers in order to work out a final version utilizing the material they wanted to include with the album.