Biomedicine on Display

Insufficient, ill-suited and overfilled storage rooms are probably the painstaking reality for many cultural history museums. At the Medical Museion, we are certainly waging an ongoing battle to resolve the problems destined to arise from ambitious acquisition activities and a very limited number of square meters of storage space. Most of the time, conservators Ion Meyer and Nicole Rehné are quite successfull in realizing the full potential of the space that we have and create high-class storage areas when we thought we had run out of options. Yet in the case of recently acquired material, which has not yet been formally added to the collections (and may never do so) we are not always able to meet the challenge. The result has been that many recent acquisitions have stranded and piled up to the extent that it is all but impossible to get an overview of what is actually there.

An obvious problem with this lack of order is that objects risk being damaged from being stored in unsuitable conditions. But another pressing concern is that some of the objects may actually be immediately relevant to exhibition or research activities at the Medical Museion.

This concern has been highlighted in course of the on-going work on “Biomedicine on Display”, the working title of a temporary exhibition set to open at the Medical Museion on 4 June 2009. Drawing on the overarching themes that have become apparent between the different research projects conducted in the framework of the “Danish Biomedicine 1955-2005“-project, the exhibition engages with the ways in which recent biomedical practices challenges the way we think about our bodies and their relation to each other and surrounding society. To this end, it is crucial that we are able to display the machines, instruments and utensils that shapes the biomedical body. And since our recent acquisition activities have focussed on the medical technologies of the past few decades, it is quite likely that we have quite a few relevant objects at our disposal already. The problem is that as long as things are stored like they are, we have no way of knowing which and how many. Basically, we run the risk of producing the exhibition, only to find that a relevant object in our possession was not included because we did not locate it.

As a consequence, we have begun the process of systematically going through the rooms we know holds relevant material in order to make the individual items accessible. The first step, which was completed during last week, was to set up shelves onto which we could objects that had been brought out and identified. Even this first task was not an easy one. As the were, the rooms in question did not offer any free space in which to set up shelves, this had to be cleared first by compressing the objects even more.

Once this was done, historian Jonas Paludan, assistant on the Biomedicine on Display exhibition, put the full force of his academic capabilities to bear on a total of 18 meters of steel shelves.

 By the end of the week, the shelves were all in place. Hopefully, we should be able to move enough material onto the shelves to set up even more on the floor space which will be vacated. Objects in bad conditions or which are stored in ways that damages them can be attended by conservators, and informed decisions can be made about whether to include individual in the collections or not. In short, even though there is much work to be done, it is good to have come this far. And it’s going to be great to be going through all those boxes!

The annual clean-out day at the Panum Institute, which houses the Medical Faculty of the University of Copenhagen, took place last week. With the sun shining from at clear blue sky and temperatures rising to the high twenties, employees at the Panum Institute went on a building-wide cleaning spree. And just like last year, Medical Museion was in position, lurking around garbage containers, ready to rescue the cultural heritage of recent biomedicine from certain destruction.

The clean-out day in 2007 produced in excess of 48 tons of waste. The numbers from this year are not in yet, but it is clear that we were nowhere near that amount. For Medical Museion, the day also resulted in the acquisition of fewer objects. One reason was that we were much more critical this year about what to take in. So when the hard work of clean-out was over and a treat of cold beer and hot saussages were handed out to the participants, we were able to enjoy our harvest of a few but very interesting (and slightly bizarre) objects.

One group of objects were three maniquins from the Department of Odontology. The training heads immediately caught the attention of Camilla Mordhorst and Monica Lambert, who saw numerous possibilities for use in the exhibition.

Another quite unexpected find was a collection of bladder stones, complete with a specially worked-out typology.

In addition to these acquisitions, the Panum Garbage Day once again proved to be a very effective means of alerting scientists to Medical Museion’s interest in quite recent biomedical equipment. It seems that the awareness that things do not have to be terribly old, rare, or valuable in order to be relevant as museum objects is spreading among the people who work with biomedical technologies every day and who are in the position to donate objects to the museum. For that reason, Medical Museion will definitely be in place for next year’s clean-out day.

As previously reported on this blog, Medical Museion set up a very temporary exhibition at the Bella Center congress center in Copenhagen this weekend. The occasion was the annual meeting of ESA, the Europan Society for Anesthesiology, and the exhibition focussed on the events, outcomes and legacies of a few very dynamic years in anesthesiology in general (and Danish anesthesiology in particular) in the early 1950s.

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The program committee of the Society for the History of Technology 2008 Annual Meeting has kindly accepted my proposed paper on ‘Biomedicine, Aesthetics, History, and Garbage: Engagements with the materialities of recent medical technology’. The conference will take place in Lisbon on 10-14 October and marks the second and final leg of the celebrations of SHOT’s fiftieth anniversary. The program comimittee made a call for papers “that concern the history of technology as it may or ought to be practiced in the future. Papers or sessions devoted to the question of how we shall write the history of technology in the future are particularly encouraged”.

I thought the activities at the Medical Museion, especially our attempts to integrate the historiography and museology of recent biomedicine as well as our interest in contemporary medical technology, might have something to offer in this respect, and I am really exited to be able to make this argument at the meeting in Lisbon. My proposal runs as follows:

Current medical science is inseparable from developments in analytical instruments and information technology. Historians have long taken account of this and have produced a range of studies on subjects like PCR-machines, visualisation technologies, genetic engineering, and biobanking. Yet for all their pervasiveness in the way medicine (in the clinical as well as in the research field) is carried out today, such recent technologies have only in very limited number made it into medical or science museums. The result is that historians who wish to engage directly with the materialities of contemporary medicine as part of their research do not have instruments, machines, and utensils as readily at hand as they often have when looking at earlier periods.

The proposed paper presents experiences gained at the Medical Museion at the University of Copenhagen in relation to the acquisition of recent biomedical technologies, and points to the challenges faced by historians and museologist who wish to collect such objects. Here, the minuscule, virtual, and intangible nature of many of the important processes in contemporary medical science poses one particularly important set of problems. The process of curating is described, and the relations between curating and more traditional ways of historical writing is discussed.

Activities at the Medical Museion have actively tried to incorporate attention to the aesthetics and design aspects of medical technologies. Engaging with technologies along these lines have allowed material aspects to play a more prominent role in the historical analyses carried out, and has led to considerations of how the visual and tactile experiences of objects can feed into historical writing. In that way, experiences at the Medical Museion point towards new ways of writing the history of medical technologies, at the same time as it begs questions about how to incorporate the sensual and material into a historiography traditionally concerned primarily with meaning and interpretation.

I look forward to receiving comments and to get in touch with others working with similar problematics. If anyone is interested in joining up for a session, you are very welcome to contact me.

This HeartMate XVE, a first-generaltion implantable LVAD (Left Ventricular Assist Device), was developed in the 1980s and cleared for use in the US and Europe in the mid-1990s. In Denmark, this so-called “mechanical heart” was first used at the Heart Center at Rigshospitalet in Copenhagen in 1998.

In 2006, Rigshospitalet shifted to the much smaller HeartMate 2, and by that time a total of 28 patients with severely impaired heart function had been equipped with a HeatMate in order to bridge the gap between the failure of their own heart and a cardiac transplant.

The HeartMate, which is basically a titanium electromechanical pump weighing around 1.6 kilos, is implanted into the abdomen of the patient. The two upper hoses are attached to the left ventricle and aorta, and the lower tube passes through the skin, allowing the pump to draw in air and to be attached to a control unit, two portable rechargeable batteries, and a monitor for inspection in hospital.

Patients have been known to be supported by the HeartMate for more than two years, and they generally experience a radical improvement in their well-being after the implantation. Some, especially younger, patients are reported to prefer a LVAD to a heart transplantation.

What is striking about the HeartMate, however, is the size, weight, and crudity of the apparatus. It simply looks like a piece of plumbing. The physical appearance obviously collides with the delicate and vital functions it performs, and certainly with the cultural image of the body part that it assists. Perhaps objects like this can work in a museum setting to exemplify the potential clash between ideas about the body and its parts shared by the public, and a more technical approach adopted by medical doctors?

Certainly, the sturdy metal casing of the HeartMate does not seem capable of incorporating the idea of the heart as the most precious part of the human body. And perhaps for that very reason (i.e. the tension between the idea of the heart and the physical appearance of the mechanical heart) this is an object that provokes instant reactions in those who engage with it. In that way, it is an amazing museum object.

This artificial femoral head was recently added to the Medical Museion’s collections. It was implanted in 1954 into a 50-year-old man suffering heavily from orthoarthritis. The operation left him 100% disabled and he lived with constant pains for the remaining thirty-three years of his life. Upon his specific request, the femoral head was recovered from the cremation furnace, the stainless steel now blackened from the intense heat. It was offered to the Medical Museion by a relative.

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A recent post on this blog about the PRECARD risk assessment software sparked a number of comments on how to handle the problem of software in museum collections. Almost by default, software becomes outdated, and it will quickly become very expensive and time-consuming (or outright impossible) to maintain it in working order. Attitudes towards this problem ranged from refraining from the collection of software and opting in stead for manuals or other documents, that will give an impression of what the software could do and looked like, to either forcing doners into providing software in a format that will allow it to be stored in working order for extended periods of time or relying upon enthusiats providing their time and skill to keep the stuff running in a bottom-up effort.

I find it very difficult to make a decision on this point. Nevertheless, decisions need to be made, simply because the dilemma of the centrality of computers to virtually every aspect of (say) recent biomedicine and the short-lived and fragile nature of computer software confronts us and will do so increasingly in the future. We thus face a major museological problem. Let me provide a concrete example of what I think may be seen as a paradigmatic case.

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At the Medical Museion, we have continuing discussion about how to handle the intangible (unhandable?) yet still material elements of recent biomedicine (genes, molecules, proteins, reagents etc.) in a museum setting. How to display what cannot be perceived? Sadly, my recent field trip to the Medica 2007 medical fair did not provide much in the way of an answer to this challenge.

Not that the intangibles of recent biomedicin were not represented at the fair. Dozens of companies advertise their product range of reagents for chemical analysis. And with the booming industry of ready-to-use lateral flow immunoassays, there is no shortage of antibody-producing companies either.

Yet how do these companies display their products? Well, as can be seen from the images below, most of the time they don’t.

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I spent a few days last week trying to keep my head above water at the 39th Medica Fair held at the Düsseldorf Messe Centre. With more than 4300 companies exhibiting their products to around 137000 visitors, Medica is the world’s largest medical fair and allows close inspection of (literally) everything from hospital ventilation systems over chemical analyzers to band aids.

The purpose of my visit was two-fold. First, how do medicotechnical companies display their products, set up exhibits, and breathe attractiveness into instruments, software, and utensils that they wish to sell; second, how, in terms of design and marketing, do exhibitors differentiate their particular products from those of compeeting companies. To my defense, it should be noted that I actually tried to pursue these two goals with some degree of perseverance. But to be honest, a lot of the time I was simply drawn in by the magnitude of the event, the endless number of objects on display, and the range of different products that somehow come together under the heading of modern medicine.

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One of the recent acquisitions of the Medical Museion is this copy of the PRECARD Version 2.1 risk assessment software. The software is used by general practitioners to calculate the risk of cardiovascular disease in the patients. Distributed freely in the form seen below, it was used by around 30% of all Danish GPs in 2003.

The software was developed by Troels Thomsen and colleagues at the Centre for Preventive Medicine at Glostrup University Hospital in Denmark, in collaboration with the Danish Heart Foundation. Initial funding was provided by Bristol-Meyers Squibb, who held exclusive distribution rights until 2002. The basis of the software were the results from large scale epidemiological studies conducted in Denmark, including the Østerbroundersøgelsen and the Glostrup Population Studies. PRECARD is the model for the HeartScore software, developed by the European Society of Cardiology, which aims to provide detailed risk assessment tools in the area of cardiovascular disease to European countries in general. At the moment, HeartScore is not able to perform as detailed risk evaluations as PRECARD since the Danish data for cardiovascular disease are more elaborate than elsewhere.

The software was collected by dr. Susanne Bauer as part of her research project “Mapping the visual and epistemic cultures of epidemiology: Individuals, populations, and the biomedical body” conducted at the Medical Museion as part of the “Recent Danish Biomedicine, 1955-2005″-project. In this context, PRECARD is an example of how information technology and visualization of epidemiological data are used in preventive medicine. Such tools may work to change the doctor-patient relationship towards joint decision-making based on probabilities, yet also enroll individuals into the logics of probabilistic health risk management.

The ‘Archeology-of-contemporary-biomedicine-garbage-day’ at the Panum Institute last June (see previous posts here and here) produced a large amount of materiale that is still in the process of being curated at the Medical Museion. The objects collected are extremely varied, ranging from surgical lamps to spectrophotometers and from the early 1900s to recent years. Most items, however, are analytical instruments from the period from 1970 to 1990, and therefore a valuable contribution to Medical Museions collections of recent medicotechnical equipment.

Several of the items, however, are related to the use of laboratory animals in biomedical research, and several of them could be seen as containers intended to produce a more or less controlled environment in which to conduct experiments on the animals. The restriction cage seen below is an obvious example.

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Last week, the Steno Museum at Aarhus University launched their most recent temporary exhibition. Named ‘ÆGløsninger‘, the display deals with reproduction, and especially with recent technologies aimed at either preventing or facilitating pregnancy. The exhibition is curated by Morten Skydsgaard and Mette Kia Krabbe Meyer.

The exhibition is aimed at a wide audience, and it makes an effort to reach school children and thus fulfill a didactic purpose important for the Steno Museum. One way to do so is to offer educational material in the areas of prevention, artificial insemination, gene technology, and cloning, and inviting visitors to take part in discussions of the ethical aspects of these new technologies.

Another very interesting strategy for engaging the audience and moving beyond tradition museum displays is to make room for interaction with the technologies presented, and to allow for the phenomenology of reproduction and related technologies to become immediately apparent. Visitors are invited to crawl into a uterus, described as “nice and soft”; computer simulation of microinsemination is supposed to give audiences “the feeling of being able to create life”; and the museum also promises to give anybody, regardless of age or sex, the possibility to experience the physical state of being pregnant.

Capturing the phenomenology of recent biomedicine is one of the issues that have been raised repeatedly at seminars at the Medical Museion, and I think that when it comes to exhibitions, the only way forward is to offer hands on-experience to visitors. Yet when it comes to written texts, the textures and temperatures of medicotechnological equipment may be much harder to include in anything but a representational and interpreted manner. 

I just finished reading the contributions in Devices and Designs: Medical Technologies in Historical Perspective, collected by Julie Anderson and Carsten Timmermann, both at the Centre for the History of Science, Technology and Medicine at the University of Manchester. The articles present very interesting and carefully researched case stories, that testify to the continuing relevance and appeal of a technological perspective in the history of medicine.

I found the title slightly misleading, however. There is much text but very little materiality in the devices under study, and equally little consideration of their morphology or the aesthetics of design. Anderson and Timmermann are well aware of this, and they regret not having been able to present chapters that “illustrate the challenge of ‘reading’ non-textual sources” (p. 7).

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Yesterday’s very productive in-house seminar at the Medical Museion concerning future exhibitions related to the ‘Danish Biomedicine 1955-2005′-project brought up a whole range of suggestions as to the type of objects that might be brought in.

Part of the discussion circled around ways in which to represent the complicated webs of interaction involved in the circulation of donor organs for transplantation. Mapping the journeys made by donor organs might have aesthetic qualities relevant in a museum context (a theme thoroughly explored at last week’s workshop ‘Biomedicine and Aesthetics in a Museum Context‘), and might also help to optimize the exchange of this scarce resource. Artist Phillip Warnell is planning a real-time tracking of donor organs in transit in Britain using GPS. And Medgadget supplies schemes documenting attempts by mathematicians to identify the optimal algorithms for the exchange of kidneys from living donors. Originally reported on the MathTrek blog, the algorithms deal with the precarious issue of pooling related but incompatible pairs of donors and would-be recipients in order to assure that kidneys offered on the precondition that a relative receives one are actually used.

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The Picker Merit low field magnetic resonance scanner represents a failed gamble in the history of MR-scanning in Danish public hospitals. Developed around 1990 by Instrumentarium in Finland , a company that was shortly after bought by Picker, the scanner was an attempt to go against the current trend at the time towards ever more powerful scanners. Supported by belief in the Overhauser effect, Picker believed that low field scanners could produce high-resolution images, and in stead of trying to make a stronger magnetic field, they worked to reduce any interference from the electrical parts of the machine. The result was a scanner that was much cheaper and lighter (1.350k), than contemporary high field imaging systems.

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