Thomas Söderqvist, “The Rise of Biomedicine and the End of the Modern Medical Museum”, Handerson Medical History Lecture, Dittrick Medical History Center, Case Western Reserve University, Thursday 31 March 2005.

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My talk today is about the present state and future of medical history museums. The specific question I wish to bring up is — what consequences will the recent revolution in biomedical research and clinical development have for our kind of museums.

When I say “revolution”, I mean the historical process that, within a few decades, has turned medicine into a molecular science and, at the same time, a highly digitalized craft Medicine today is a very different kind of medicine than that we know from medical history books and medical museum exhibitions.

So my question today is: How shall museums accomodate to these major changes in late 20th and early 21th century medicine?

I am going to address this question with reference to my own institution — the Medical Museion in Copenhagen, and work we are doing right now to renew the old medical-history museum (blank- 2)

And I’d like to start on a personal note — how I happened to get involved in the medical history museum business. I do not have a long and distinguished background in museums. My major research contributions have been in the historiography of 20th century science: I wrote about the history of ecology for my PhD, and then I have done some quite extensive work on the history of immunology — and I spent the better part of the 1990s writing a biography of the immunologist Niels Jerne, who got a medical Nobel in 1984 for his theories of the immune system; theories that led, among other things, to monoclonal antibodies.

So I’ve never really paid much attention to medical history museums until recently. In fact, my interest in medical museology came only after I got the job as professor of history of medicine at the University of Copenhagen five years ago.

The announcement for the job didn’t say anything about museum responsibilities. But the Dean made it clear in the interview that he hoped I would also take the responsibility for the university’s medical history museum. Which I had heard about, but never visited. So I went downtown to see it — and realized that this was indeed an offer no one could resist. The museum is housed in the former Royal Academy of Surgeons (pic 3) a late 18th century stately building in the inner city area (pic 4) — some 60.000 square feet altogether. Here’s (pic 5) the main stairway, here’s (pic 6) the old anatomical theatre from 1787.

The collections were established exactly 99 years ago, in 1906, and for decades generations of Copenhagen doctors, hospitals and research institutions made extensive donations to the growing museum.

And what I saw was simply stunning: There’s an exquisite microscope collection with hundred of microscopes from 18th centiry and omwards.. There’s an absolutely unique X-ray collection, including a large number of early cathode ray-tubes. Here’s (pic 7) the large and well-assorted obstetric-gynecological collection with (pic 7a) contraceptive devices, instruments from the 18th century and onwards, and a number of extremely well-preserved“babies in pickles” (pic 9). Then (pic 10) there’s a huge dentistry collection with soke interesting details (pic 11). And a huge pharmacy collection with a handfull of complete apothecaries from 18th century and onwards, including nice majolicas (pic 12) and some old pharmaceutical laboratories(pic 13-14). We’ve got a very fine ophtalmological collection, also with some fine details (pic 15). And (pic 16) a surgical collection with many instruments going back to mid-18th century, plus things like this artifical hand (pic 17). The usual pathological preparations (pic 18) and moulages (pic 19) And not least a world-famous osteopathological collection (pic 20) , largely from medieval leprosaria, etc. etc.

Some estimates said there were around a hundred thousand items. Mostly 19th and 20th century, but some go back to early and mid-18th century. And in addition there are some 500 paintings, like these ones (pic 21-22-23), and some 60.000 photos and drawings, plus a large archive that includes, among other things, complete hospital patient records back to late 18th century). And finally a 30.000+ volume library. All owned by the university. It’s one of Europe’s biggest and richest medical history collections.

Yet – I was not amused. Because the whole place was in a bad shape. The buildings were worn down. Only some 20% of the collections seemed to be registered (nobody really knew how much). The staff was unprofessional and (frankly) unfriendly. The collections were run by a dozen amateur curators, former medical professors who guarded each his or her treasure chamber. There was almost no research going on. The exhibits had hardly been revised since the early 1970s. And there had been very little collecting activity for the last three or four decades. So when the Dean asked me: “We thought you might perhaps be interested in …” — my spontaneous response was: “No way!”

But I gave it a second thought, because I realized that this was, after all, the chance of a life-time. It was all so ramshackled — and yet so full of opportunities. So I struck a deal with the Dean. I would accept to take care of the place if he gave the necessary political backing to hire professional staff, and free hands to reconstruct the old museum into a modern research-based institution.

And that’s what we’ve been trying to do in the last 5 years. So now I want to present some of the ideas behind this re-orientation – the kind of place we are trying to create — and especially the problems we are confronting.

First, it is not unimportant what name you give to an institution. The place used to be called the “Medical-History Museum” (pic 24). But I thought we ought to get away from the conceptual limitations that stick with the word “museum”. We do collect, and we do exhibit. But we also wanted to emphasize that these acitivites are research-based — that we are thinking in terms of a university department, with collections and exhibitions — not a museum with a research unit.

That’s how the name Medical Museion came up (pic 25). The old greek word “mouseion” — which was the name used for the renowned center of learning in Alexandria — was a better word to signal our purpose, I thought, than the latin word “museum”, which began to be used for collection in the Renaissance and early modern period. Not a pure research and teaching department — nor a pure museum. But both. So that’s one of the main ideas behind the Medical Museion concept. To bridge the usual gap between:
– on the one hand, an academic medical history research and teaching culture that focuses on text production, and
– on the other hand, a curatorial culture that focuses on the collection, preservation and exhibiton of material objects, images and archives (blank-26)

The other main idea behind the Medical Museion concept is to focus on the recent biomedical revolution.

There are good reasons to do this. First, because there is already a lot of interesting things going on research-wise. The development of recent biomedicine is already reflected in a rapidly growing historical literature — on the history of genetics, the history of immunology, history of aids, history of organ transplantation, the history of PCR, and so forth – work done by historians, sociologists and anthropologists of science, people with a “science studies”-perspective, by clinicinans with a historical interest, etc. And (to mention my own personal scholarly interest) — there have been quite a few, decent biographies of recent biomedical scientists.

But — and this an even better reason to focus on the recent biomedical revolution — if you look at the collecting and exhibition side of recent biomedicine there has been very little done, so far. With the exception of the Science Museum in Lonond and a few others, very few museums have taken the recent biomedicical revolution seriously. And even fewer museums have begun to collect (systematically) the recent biomedical heritage.

In other words, most medical history museums – at least in Europe — still give a picture of medicine as it looked from the mid-19th to the mid-20th centuries — i.e., before the biomedical revolution became visible to historians of medicine and medical history museum people.

So that’s how we see the aims of the Medical Museion. And we’ve just been so lucky to receive substantial funding to pursue this approach. So right now we’re recruiting a handfull of postdocs who are supposed to combine 1) research into late 20th century biomedicine with 2) collecting from Copenhagen clinics and biomedical research laboratories and 3) work on the new exhibitions.

***

So that’s the history and idea behind the Medical Museion. But now the real challenge comes. Because, by taking recent biomedicine seriously, by focusing our research, collecting and exhibition activities on the last 50 years, we run straight into a major museological problem — the one I started my talk with — viz., how shall we accomodate to the major changes in late 20th and early 21th century medicine?

The challenge has to do, as I see it, with the notions of “materiality” and “tangibility” and what a museum “object” is. Museum people don’t agree about much. But one thing they do agree upon, is that museums are institutions that deal with material objects and culture. (In contrast to archival institutions that collect documents. In contrast to iconographical collections that work with images. In contrast to libraries, and so forth.)

They agree that museums are institutions that collect and exhibit tangible objects — things like hospital beds, surgical instruments, contraceptive devices, iron lungs, patho-anatomical specimens, etc. And medical history museum curators usually don’t see any problem in defining what an “object” is — or what constitutes a “good” museum object. A “good” museum object is concrete, sensual, spectacular. All curators agree — a good exhibition object is one that triggers the visitors’ attention, elicits their memories, evokes their emotions, makes them pause in front of the object with a sense of curiosity and wonder.

Here are some typical “good” classical objects (pic 27). They are made of easily recognizable materials (in this case metal). They look like familiar tools. Anybody can easily understand their function. You’re probably familiar with these obstetric forceps (pic 28) which were invented to aid in the delivery of the baby — or this lithotriptort (pic 29) which was used to pull out bladder stones.

All medical history museums love these and similar objects – slow, foot-driven dentist’s drills, siamese twins in jars, amputation saws, trepanation drills in handy travel sets, etc. They are “good” medical museum objects, because they are immediately understandable and also appeal to our fear of pain and death.

The lithotriptor, for example, is extremely popular among our student guides. Almost every week we have group of high-school students, and there’s alway one or two noisy smart-asses in the group. The remedy is the lithotriptor – “So what’s this?”, the guide asks one of the smart-asses. “Uhu?” he says, and then she explains bladder stones, how they can kill you, and how it is necessary to remove them. “So how could they do that?”, one of the nice girls in the group asks. “Well”, says the guide — looking intensely at the smart-ass — “it was introduced the natural way”. He looks bewildered, and when she adds: “… before anaesthesia”, he turns pale in his face – some of them even faint – and the rest of the hour the group is domesticized like a herd of lambs (blank-30)

Now, my point is that the emergence of recent biomedicine challenges this classical notion of the medical history museum as collections and exhibitions of material, tangible objects.

This challenge emerges from the two major features of recent biomedicine that I hinted at before — molecularization and digitalization.

First, the pervasive molecularization of medicine. In principle it goes back all the way to 19th century physiology and early 20th century biochemistry — the understanding of intermediary metabolism was, of course, part of a molecular understanding of the human body.

But when we talk about the molecularization of medicine, we’re usua,,,hy thinking pimarily of the effects of molecular biology that came with the understanding of the role of DNA in protein synthesis — from the early 1950s, with the discovery of the DNA double helix model, to the complete sequence of the human genome in 2001. And we’re thinking of all the laboratory technologies that have come out of molecular biology – technologies which are now having a strong impact — not only on basic biomedical research, but also on diagnostics — and which are also begiining to have an impact on therapeutics in the form of specific molecular therapy and even gene therapy.

The other aspect of the biomedical revolution (digitalization) has not only changed biomedical research practices drastically, but also diagnostics and all different sorts of hospital treatment. A clinical biochemical laboratory in a major hospital today — the spider in the hospital web — is dominated by the robotized analyzing systems. Few clinical chemical tests are done manually today.

And if you have visited a neonatal ward recently, or if you have been sitting with somebody who is dying in an intensive care unit — then you know that both are as digitalized as the cockpit in a Boeing 747 — with CPAPs, screens that monitor oxygen levels, etc. etc.

Likewise, major diagnostic tools like CT-scanning, MR-scanning, PET-scanning and other imaging technologies are impossible to imagine without digital technology.

My point is that both these trends — both the molecularization and digitilization of medicine — have deep consequences for what we mean by a museum “object” today, and for how we concieve of the medical history museum of the future. And these consequences have to do with the fact that today’s medical objects are neither concrete, nor tangible, neither sensual, nor emotionally evocative.

Take this pill as an example (pill) — Losec, the best-selling drug in the world in the last 15 years. In the good old days, when you had a gastric ulcer, you consulted a surgeon who performed an operation with knives and forcepses — material, tangible objects. Today, you take 10-40 mgs of omeprazol, a carefully designed molecule, which acts specifically by blocking the hydrogen ion pump in the gastric lining. The design of this new “molecular knife” is based on intricate knowledge about the molecular mechanism of the ion channels — and in contrast to the material, tangible knife and forceps of the classical surgeon, this molecular knife is hardly “material” in the sense that museum curators speak about materiality. It is clearly not “tangible” either.

So the problem is: What is the museum “object” here? The pill as such is rather uninteresting, it looks like all other pills, — it’s the zillions of omeprazol molecules which are the interesting things here — but it takes a whole chapter in a textbook of cell biology to explain their function – and you cannot display them in any meaningful way, as you can display a real, tangible metal knife.

Take another example — gene array technology. (pic 31) Here’s a “Human Genome U133A Array” från the Californian biotech company Affymetrix. The “gene chip”, as it is called, is a really useful object in medical research and diagnostics today — (pic 32) Financial Times recently had it on their first page. (pic 33) The ½ x ½ inch chip has about half a million minute areas which each contains millions of well-defined nucleotide sequences of single-stranded DNA — the chip is an array of molecular “probes” that react with nucleic acids sequences prepared from a tissue sample — and these sequences in turn are a measure of the gene expression level in the sample.

In effect this tiny little chip then can “read” the expression level of half the human genome, i.e. about 15.000 human genes (pic 34)– or as Affymetrix writes in the product specification: It analyzes “the expression level of 18,400 transcripts and variants, including 14,500 well-characterized human genes”. Imagine that text on a label in a show-case!

Now, this gene chip is a revolution in medical diagnostics — it’s an extremely powerful test for mutations — and therefore it provides the means for an individualized molecular therapy.

But — what’s the museum object here? What you see when we put it in a show-case is just the handy plastic casing. The 10 x 10 mm chip is on the inside, invisible. The single-stranded DNA-probes are invisible too, and pretty intangible. And the scanner that reads the expression patterns on the chip (pic 35) looks like a photocopy machine.

In other words – the whole gene array technology makes for a lousy museum objects — because they are so abstract, intangible and hardly evoke any memories or strong emotional reactions.

My third example raises a related problem for medical history museums — namely that the limit between physical “objects”, “images” and “texts” tends to become blurred. (pic 36) Here is a PET-scanner (PET stands for positron emission tomography), the last in the series of smart imaging technologies. It works in this way: The patient is injected with sugar molecules that are marked with a short-life radioactive isotope — which sends out positrons — which are caught by a detector. The brain in the machine is a computer program which interprets the positron signals — and then produces a 3D-interpretation of the suger metabolism in the patient’s body. Like here (pic 37) in an Alzheimer patient brain.

So far so good. But now comes the museological question: what’s “object”, what’s “image” and what’s “text” in the PET-scanner? The immediately visible physical parts of the PET-scanner — the “tangible” museum “objects”, like the bed and the plastic casing — they don’t give any clue whatsoever about the use and function of the machine. Fair enough, the other physical parts — the positron detector and the computer hardware — are indeed “tangible”, but they are difficult to dispaly in any meaningful way in a museum contrext. And forget everything about the short-lived isotope molecules. Furthermore, the whole physical hardware is secondary to the “image”. And this “image”, in turn, is a representation of the signals from the isotopes — a representation which is made possible by the “text”, i.e. millions of lines of code in the computer program..

So the question is — is the PET-scanner a museum “object”, an “image” or “a texT” – or all three things at the same time? And where does it belong — in the “museum collection”, in the “ iconographic collection” or in the “archive”?

These are three examples that I believe illustrate that we have a problem if we want to collect and exhibit recent biomedicine in a medical museum context. To put it as strongly as possible — I believe that medical history museums are caught in a paradox.

On the one hand, biomedical research and technology fills more and more of our lives — from the neonatal care unit, to the threshold of the grave. In fact, biomedical science influences our lives infinitely more today than it did in those days when the lithoclast was used without anaesthesia.

Which means that as museum people, we have a strong obligation to begin to collect and document this recent biomedical heritage – because if we don’t do so now, the rapid turnover of scientific and clinical technologies and practicies will make it disappear sooner than we would like to think.

On the other hand – the whole idea of a museum collection and a museum exhibition becomes questionable. Diagnostics and treatment has become less and less visible, less and less sensual. Recent biomedical “objects” like Losec-pills, gene-chips become smaller and smaller, more and more abstract, less and less tangible, less and less emotionally evocative — and there comes a point when it isn’t really meaningful to show such “objects” in the medical history museum exhibitions.

Likewise medical instruments and apparatuses become more an more anonymous. Most medical technology today is plastic cabinets filled with electronics and blinking diodes. The exterior tell very little, if anything, about the function. a A This gene-sequencer (pic 38) could perhaops be a super dishwasher. And this PCR-analyzer (pic 39) could be a fax machine.

Will such things work in an museum exhibition context? Who wants to take the family to a museum on a nice Sunday afternoon to read computer manuals, look at machines called “Perkin-Elmer” og “Hewlett-Peckard”, or see large video screens with 3D-animated omeprazol molecule in action? Won’t those of us, who are curious about recent biomedicine, rather download the molecular images on the computer at home instead? Or if we are interested in seeing how the PCR and the gene array technologies work – won’t we rather look it up in a book or a magazine article?

To sum up — in my view, recent biomedicine is a great challenge to the traditional notion of what a medical history museum is. I believe this is a genuine museological problem. A problem that we will have to solve, now that we are trying to build a Medical Museion that focuses on recent biomedicine.

I’m not pretending to have a solution in sight – or a smart way of circumventing it. So I would very grateful for any constructive comments.
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