When creating the concept for the exhibition The Body Collected, I investigated the use of human tissue in medicine from 19th century pathological museums to today’s biobanks containing small samples of frozen tissue. On the surface the museum and the biobank are very different kinds of places. But on closer inspection? We are easily led by images, metaphors and rhetoric. To start with the imagery, it could hardly be more different. The medical museum with its Victorian display in wooden vitrines and the recognizable body parts carrying a mixed sense of humanity and death. Contrast that with the blue lit, clean surfaces and robotic handling of unrecognizable samples depicted on the websites of the recently founded national biobanks.
Museums and Banks
Also the metaphors of “museum” and “bank” indicate different functions. Museums are associated with the past and their role is to study and conserve old materials. The bank is a place for safeguarding resources for the future, growing them and returning them with interest. This image is supported by the rhetoric surrounding large national biobank projects. For instance, at the opening of the Danish National Biobank the minister of research stated that ‘The currency of this bank is biological samples and the return is research results that will benefit the whole population’. But what happens if we look more closely at the practices in biobanks. During a recent visit to the new Danish National Biobank on entering a top modern lab equipment I saw a group of lab assistants working with a pile of old, black
boxes full of cards and large books with hand-written registrations. They were pulling out staples and registering information on computer. At the same time old blood samples from cardboard boxes were transported in from storage and repacked. The activities looked exactly like repacking and registering historical collections in museums. And indeed this was what was taking place. The Danish National Biobank holds several highly valuable collections of older diagnostic samples, which together with the comprehensive registration of health data in Denmark provides unique possibilities for associating biomarkers and genetic profiles with the disease history of the sampled persons. My claim is thus that the seeming differences between collections in medical museums and those in biobanks are misleading. That although the laboratory revolution has changed medicine immeasurably, it has not changed the fact that medicine is a collection science. And although medicine is not normally regarded as a collection science – in the way of natural history – collecting is a continuous and ongoing part of generating medical knowledge.
Collecting in Pathological and Anatomical Museums
To start with the pathological collections in the medical museums, these were collected with a view to categorizing and thereby understanding disease. With the rise of hospital medicine in the 19th century patients were gathered in wards and it became possible to compare cases. When the outcome was bad patients were often dissected and it was thereby possible to document the lesions in the organs together with the case history containing symptoms of the living patient. The collections thereby served a way to accumulate medical experience in material form, which could be studied away from the chaos of the clinic. The cases from the past could thereby be used to improve and sharpen new diagnoses because both the physical symptoms, the internal lesions and the final diagnosis were known. This materialized experience was carefully registered and stored in pathological collections.
Collecting in Biobanks
As medical interest shifted towards the cellular level and later to molecular biology, the collections contained smaller and smaller samples of tissue. Microscope slides were kept in archives and investigated through microscopes, and samples of blood and other tissue preserved in freezers and analysed biochemically. Starting with small collections of individual researchers, collections grew along the same pattern as the anatomical and pathological collections to large institutional collections. National biobanks took off in the early 21st century with the aim to gather collections capable of representing a whole population. A main aim is to collect samples from citizens and then follow the development of their health and disease. The data and samples collected allow researchers to match diseases with particular biomarkers and thus make diagnostic predictions both earlier and more precise, and to choose the best treatment for patients once diagnosed. In this way it is only when collections becomes “historical” will they become truly useful as the full case history has infolded. One valuable collection of this sort is the collection of blood samples taken at neonatal screeningin Denmark where health data and genetic analyses of blood samples from 1982 and onwards can be matched to develop better diagnostic techniques.
On the surface there appears to be a change from the museum where specimens are investigated with sight and scalpel to the biobank where samples are investigated in the laboratory. This fits well with the story of laboratory revolution that changed biology and medicine into lab sciences. It is, however, possible to nuance this story and show that collection did not disappear in biomedicine.
Medicine as a Collection Science
If we broaden out the notion of scientific methods drawing on John Pickstone’s Ways of Knowing (2010) we can distinguish a number of scientific “ways of knowing” such as reading, collecting, analyzing, experimenting. Pickstone sees a historical development through the different practices, but emphasizes that they can coexist. And this is what I believe is the case in the biobank, where museum-style collection practices coexist with experimental laboratory techniques. The importance of collection practices in laboratory science has also been noted by the historian of modern biology, Bruno Strasser. He has drawn an analogy between collection in natural history museums and various forms of collection in molecular biology such as proteins, serum and genetic data. The connection is, I argu e, even stronger in the case of medicine where we can trace a continuous and ongoing focus on collection in medical research. Neither of these two authors, however, focus on the materiality, but it is exactly the fact that collections contain actual physical samples that is central in collection sciences. Physical specimens and samples contain latent knowledge i.e. it will be possible to uncover new knowledge from the sample as questions and methods change. Physical specimens are, of course, also formed by specific interests at the time of collection, but they are amenable to new questions in the future. To sum up, pathological collections and biobanks resemble each other in the following significant ways.
- They employ of ‘museum’ practices of preservation, registration and storage.
- They use past diagnoses to understand diseases in the present.
- They constitute the material connection between the clinic and medical research by bringing the patient’s body from the hospital to the research collection.
The ongoing importance of collections and collection practices thus means that:
- Medicine should be regarded as a collection science.
- Biobanks may be characterized as medical museums for very small samples.
Comparing the two institutions also bring out important aspects in both. Modern biomedicine is often characterized as disembodied because tissue culture and data crunching seems to be removing it from real bodies. The biobank collections, however, show how the physical samples of particular patients are regarded as essential. As for pathological museum collections, these have been shown in recent years to be less rigid in the categorisations than has previously been assumed. So instead of museums being of the past and biobanks for the future, both may be seen to use the past to answer future questions.
This material is published in an extended form in: Tybjerg, K. (2015) “From Bottled Babies to Biobanks: Anatomical Collections in the 21st Century” in The Fate of Anatomical Collections, R. Knoeff & R. Zwijnenberg (eds). Ashgate Press.