Biomedicine on Display

Recently I announced a quiz to get more information about a historical syringe that a couple of friends had bought for me. This quiz was far from easy since we had no information on the syringe whatsoever. Medical Museion’s guest researcher and former chief physician Sven Erik Hansen was the first to make a suggestion on our Danish blog — he thought it might had been be used to treat haemorrhoids.

Sven Erik’s was a qualified guess, but it seems like the area of expertise that we are dealing with here is rather odontology. Thomas put a query about the syringe on rete, the mailing list for curators, historians, students, collectors, dealers, etc, interested in the history of scientific instruments, and immediately received some very interesting answers. First out was Frank Manasek: 

This type of syringe was common in dentistry or in minor surgery where local anesthetics (such as lidocaine) would be used. Later syringes of this style were designed to use disposable ampoules of anesthetic, and disposable needles. (This one predates both.) The needle on this example is long, suggesting its use in mandibular blocks.

Following Franks lead Alistair Kwan elaborated:

I was just about to write almost the same thing. The last time I asked a dentist about the move away from these, he said that patients are more scared of them because they are big and shiny, and harder to
keep out of sight — convenience and cost of disposables did not play into his decision, though they are primary issues in debates between surgeons, surgical nurses and hospital administrators.

If you compare with today’s common disposables, the plunger design involves a different handhold that increases control through tight spaces and increases pressure on the contents. If you try them out, you can experience how the palm-grip hold is much less subject to little wobbles in the finger and thumb joints. (A high-stability grip for the disposables is to wrap them in all four fingers of a fist, which limits where you can work.)

You can also experience how the palm-grip hold and the lighter two-finger hold are suited to injecting targets at different heights and orientations. You cannot comfortably inject straight down with the
palm grip hold unless you are leaning right over the patient. But your forearm is positioned for easy aiming sideways or forwards or upwards, as into the nerves in the mandibular joint.

For times when you want a pistol or palm grip (e.g. in veterinary medicine), there are handles for disposable syringes. The handles derive from earlier syringes in which they were inbuilt. In recent years (decades?) they have simply had the syringe removed, leaving a hollow or brackets in which to insert a disposable. Similarly with ring grips, now marketed for use by non-medical people with frail hands who need to administer to themselves or family members, and for cake decorating.

Easy disassembly makes cleaning easier but it sometimes owes more to manufacturing processes than concern for scrubbing and autoclaving. A device like this is often cheaper to mass-produce from standard stock than by building all components from scratch. If it goes together easily, it often follows that it comes apart easily as well. Today’s one-way barbed fasteners and sonic welders have of course
cancelled that rule.

Now what began as an artefact without a history suddenly had spawned a fascinating insight into the world of dentistry. Peter Morris continued (still on the rete list):

These syringes are still in very common use by dentists in the UK. I don’t recognise the disposables mentioned by Alistair. Personally I always try to avoid the jab if I can which provokes friction between me and the dentist. I would say the needle is a little bit thicker than it appears in the photograph, but it may just be a matter of the scale of the photograph (and the psychological effect of it going into your mouth). A quick look on the web throws up JS Dental Manufacturing Inc of Ridgefield Connecticut. I cannot find out how long it has been in business but it seems well established.

And back to Alistair:

I should clarify a bit though: the common disposables are less stable than the big dental model when used in the mouth owing to how they  have to be held. What I originally wrote (in a low-energy moment at the end of work yesterday) was unclear, though I’m sure that your exhibit writers will have no trouble doing better. (I’m now at the start of the day so am more critical of what I write!)

And that critical attitude might be what made Alistair return with one last comment:

It might also be worth indicating that some anaesthesia techniques begin with aspirating by withdrawing the plunger to suck a little on the tissue that the needle has entered. This tests whether you are in the right place: the colour of the liquid obtained indicates the extent of blood supply. If you get blood, you know to withdraw the needle and start again. (I find needle-guiding techniques very clever. Other common rules are to locate external markers for guidance, and to hit bone or a sudden resistance change as an indicator for depth. Some markers for mandibular anaesthesia are in the ear which is why the dentist puts his finger there — as target to aim for — while inserting the needle.)

Aspiration is reflected in some plunger handles: they have a ring for the thumb.

It’s more difficult to aspirate with pistol-grip and palm-grip syringes because pulling and pushing require different holds. That may entail having an assistant steady the patient’s head.

Following Peter’s post, I had a quick look at some on-line catalogues and saw that both metal and disposable plastic syringes are sold by dental equipment suppliers.

So thanks to our fellow histrorians and curators on the rete list, we’ve been able to construct a much more detailed curatorial story about the syringe than I ever imagined when I first posted the original quiz.

And so we need a winner. The stern panel of judges (who will remain anonymous) has decided to a name Alistair Kwan the winner. So Alistair, whenever you come to Copenhagen, please visit us here at Medical Museion and claim your prize.

Medical museums are usually full with old and new medical science instruments. But they tend to be kept in storage because it is difficult to display them in a meaningful way. It’s much easier to put moulages, pickled organs and surgical instruments on show. Medical science instruments usually need truckloads of description and contextualisaton to make sense in museum displays. (Probably because they don’t ‘talk’, some people would say :-)

Neither do many museum curators give much thought to the historicity of their display techniques. How have display practices changed over time and how do these practices reflect museum culture, politics and technologies?

Such question wil hopefully be discussed at the 29th symposium of the Scientific Instrument Commission, which will be held in Firenze, 4-9 October 2010 on the theme ‘Instruments on display’, i.e., how instruments have been presented in scientific collections, museums and permanent and temporary exhibitions throughout modern history up to the present:

Did didactic, scientific, celebrative, propagandistic and rhetorical considerations significantly influence the manner of displaying instruments? How were instruments presented in a Wunderkammer of the Renaissance, in a 18th-century cabinet or in a 19th-century exhibition? How and why are they shown in contemporary science museums?

This year’s symposium is sponsored and organized by Istituto e Museo di Storia della Scienza (Museo Galileo) and Fondazione Scienza e Tecnica. The meeting is open to “anyone interested in the history, preservation, documentation of use of scientific instruments”, whether academic scholars, curators, collectors or students.

Send abstract before 1 June, 2010 by filling in this template.
More info on the symposium website.

A couple of friends who know about my interest in the history of disease recently gave me a historical syringe as a gift. They bought it in a flea marked, so unfortunately I don’t have any information about its provenance. Ion Meyer (conservator and head of collections here at the Medical Museion) suggests, with some help from catalogues of medical equipment, that it might have been made in 1940’s or 1950’s, but unfortunately we could not get any closer.

And this is where you, dear reader, might be of assistance:

• Where and when is it from?
• How common was this particular type of syringe?
• When did it go out of style?

The syringe is marked JS and is easily dismantled as seen below.

This quiz will continue until January 31. There will be a small prize (a guided tour of Medical Museion by yours truly) to the person that can give me the most detailed story about the syringe. The winner will be elected by a judging panel assembled for the occasion and announced on 1 February. Good luck!

The 15th biannual conference of the European Association of Museums for the History of Medical Sciences (EAMHMS) will be held at the University of Copenhagen, 16–18 September, 2010.

This year’s conference focuses on the challenge to museums posed by contemporary developments in medical science and technology.

The image of medicine that emerges from most museum galleries and exhibitions is still dominated by pre-modern and modern understandings of an anatomical and physiological body, and by the diagnostic and therapeutical methods and instruments used to intervene with the body at the ‘molar’ and tangible level — limbs, organs, tissues, etc.

The rapid transition in the medical and health sciences and technologies over the last 50 years — towards a molecular understanding of human body in health and disease and the rise of a host of molecular and digital technologies for investigating and intervening with the body — is still largely absent in museum collections and exhibitions.

As a consequence, the public can rarely rely on museums to get an understanding of the development and impact of the medical and health sciences in the last 50 years. Biochemistry and molecular biology have resulted in entirely new diagnostic methods and therapeutic regimes and a flourishing biotech industry. The elucidation of the human genome and the emergence of proteomics has opened up the possibility of personalised molecular medicine. Advances in the material sciences and information technology have given rise to a innovative and highly productive medical device industry, which is radically transforming medical practices. But few museums have so far engaged seriously and in a sustained way with these and similar phenomena in the recent history of medical sciences and technologies.

The contemporary transition in medical and health science and technology towards molecularisation, miniaturisation, mediated visualisation, digitalisation and intangibilisation is a major challenge for the museum world; not only for medical museums, but also for museums of science and technology, and indeed for all kinds of museums with an interest in the human body and the methods for intervening with it, including art museums, natural history museums and museums of cultural history.

Contemporary medicine is not only a challenge to exhibition design practices and public outreach strategies but also to acquisition methodologies, collection management and collection-based research. How do museums today handle the material and visual heritage of contemporary medical and health science and technology? How do curators wield the increasing amount and kinds of intangible scientific and digital objects? Which intellectual, conceptual, and practical questions does this challenge give rise to?

The meeting will address questions like (but not limited to):

• How can an increasingly microanatomical, molecularised, invisible and intangible (mediated) human body be represented in a museum setting? Does the post-anatomical body require new kinds of museum displays?
• How can museums make sense of contemporary molecular-based and digitalised diagnostic and thereapeutic technologies, instrumentation and investigation practices in their display practices?
• How can museums make use of their older collections together with new acquisitions from contemporary medicine and health science and technology?
• What is the role of the visual vs. the non-visual (hearing, smell, taste, touch) senses in curatorial practice and in the public displays of contemporary medical science and technology?
• What can museums learn from science centers, art-science event venues etc. with respect to the public engagement with contemporary medical science and technology? And, vice versa, what can museums provide that these institutions cannot?
• How can museums draw on bioart, ‘wet art’ and other art forms to stimulate public engagement with the changing medical and health system?
• How does physical representations of contemporary medicine in museums spaces relate to textual representations in print and digital representations on the web?
• How can museums integrate emerging social web technologies (Wikipedia, Facebook, Twitter, blogs, etc.) in the build-up of medical and health exhibitions?
• What kind of acquisition methods and policies are needed for museums to catch up with the development of contemporary medical science and technology, especially the proliferation of molecular and digital artefacts and images?
• What kind of problems do museum encounter when they expand the acquisition domain from traditional textual, visual and tangible material objects to digital artefacts (including software, audio- and videorecordings, and digitally stored data) and non-tangible scientific objects.
• How can participatory acquisitioning, crowd-sourcing, wiki-based methods, etc. (‘museum 2.0’) be employed for the preservation and curation of the contemporary medical heritage?
• How can curatorial work in museums draw on medical research and engineering and on academic scholarship in the humanities and social sciences? And, vice versa, how can museums contribute to medical teaching and research and how can their collections stimulate the use of physical objects in the humanities and social sciences?

The conference will employ a variety of session formats. In addition to keynotes and sessions with individual presentations of current research and curatorial work there will also be discussion panels and object demonstration workshops.

We welcome submissions from a wide range of scholars and specialists — including, for example, curators in medical, science and technology museums; scholars in the history, philosophy and social studies of medicine, science and technology; scholars in science and technology studies, science communication studies, museum studies, material studies and visual culture studies; biomedical scientists and clinical specialists; medical, health and pharma industry specialists with an interest in science communication; engineers and designers in the medical device industry; artists, designers and architects with an interest in museum displays, etc.

We are especially interested in presentations that involve the use of material and visual artefacts and we therefore encourage participants to bring illustrative and evocative (tangible or non-tangible) objects for demonstration.

The meeting will begin on Thursday 16 September (noon) and end on Saturday evening 19 September, 2010.

100-300 word proposals for presentations, demonstrations, discussion panels, etc. shall be sent before 28 February 2010 to the chair of the program committee, Thomas Soderqvist, ths@sund.ku.dk.

A meeting website for registration and hotel bookings will be established in early January 2010. A number of hotel rooms will be prebooked.

Programme committee:
Ken Arnold, Wellcome Collection, London
Robert Bud, Science Museum, London
Judy Chelnick, National Museum of American History, Washington, D.C.
Mieneke te Hennepe, Boerhaave Museum, Leiden
Thomas Soderqvist, Medical Museion, University of Copenhagen (chair).

Local organising committee:
Anni Harris, Bente Vinge Pedersen, Carsten Holt, Morten Bulow and Thomas Soderqvist, Medical Museion, University of Copenhagen.

For further information about the academic programme, please contact Thomas Soderqvist, ths@sund.ku.dk. For practical information about travel, accommodation, etc., see http://www.mm.ku.dk/sker/eamhms.aspx, or contact Anni Harris, konference2010@sund.ku.dk after 4 January 2010.

The conference is hosted by Medical Museion; further information will be posted on the museum’s website (www.museion.ku.dk) and on this blog.

One of the challenges for a museum of medicine intent on collecting recent and contemporary medical artefacts is to get an overview of the historical development of medical instruments, medical technological systems and the medical device industry.

Trade shows and their catalogues (published or online) are excellent sources. But memoirs and reminiscences of people who have been engaged in the trade show business can also be useful —  they add a more personal perspective to the dry historical data, they are more fun to read than catalogues, and you can probably construct a useful picture of trends by piecing their more or less idiosyncratic stories together.

Take for example Wolfgang Albath, a pioneer in laboratory medicine and one of the founding organisers of the world`s largest medical trade show, MEDICA in Düsseldorf,. He has just summarized, shortly, his view of some of the important trends in the last 40 years of medical hospital technology (in the 12 Nov online issue of European Hospital):

Medica trade show 1974

In summary, his view of the recent history can be described in three words: mechanisation, automation and digitalisation. When MEDICA started (in Karlsruhe) in 1969, it focused exclusive on laboratory diagnostics. Most lab analysis were then carried out manually and in pretty small series.

One of the few automatic systems was the Technicon Auto-Analyzer, introduced around 1960; for a contemporary evaluation of it, see here): “Based on a system of continuous flow analysis [the Technicon AA] revolutionised lab diagnostics and paved the way for analysers to work through organ-specific parameters in batches”.

In the 1970s came immunofluorescent techniques for detecting auto-antibodies and infectious agents, and in the 1990s advances in molecular biology opened new diagnostic opportunities at the picomolar level.

Iinformation and communication technology has not only made possible automation in the clinical lab, but all kinds of hospital practices. The first patient monitoring systems, which are now taken for granted in intensive care and neonatal unit, were introduced in operating rooms and wards in the mid-1960s. In the clinical laboratory, computer development made possible large-scale diagnostic tests in the 1970s.

Another area which depends heavily on IT  is radiology and medical imaging. In the 1960s “the triumph of real-time ultrasound diagnostics began”; in the 1970s came the CT-scanner; the first digital image archives, radiology information systems and laboratory information systems arrived in the mid-1980s; about the same time came MRI, and in the 1990s PET. 3D reconstructions of CT, MR and ultrasound images also became possible in the mid-1990s.

Surgery too has undergone enormous technological changes; eg., keyhole (laparoscopic) surgery began in gynaecology in 1969; the first keyhole gallbladder removal was performed in 1985 and in the early 1990s keyhole surgery in the abdomen. And then there is laser technology which has “lit up the medical sky” for 30 years, not least in ophthalmology, where doctors hardly cannot imagine work without lasers today.

While we are waiting for the sequel to Joel Howell’s seminal Technology and the Hospital: Transforming Patient Care in the Early Twentieth Century (Johns Hopkins University Press, 1996), reminiscences like Albath’s are among the best ways to get an overview of the complexities of the recent history of medical technology. I haven’t made a systematic search for memoirs and reminiscences of similar kinds — but I’m convinced there are many out there, although they can be difficult to find.

(Btw, for a useful academic course syllabus for the history of medical technology, see here).

The creative editors or Spontaneous Generations: A Journal for the History and Philosophy of Science (see earlier mention here) are planning a focused discussion section on scientific instruments in a forthcoming issue of the journal.

With the “practical turn” in history and philosophy of science came a renewed interest in scientific instruments. Although they have become a nexus for worries about empiricism and standards of evidence, instruments only rarely feature as primary sources for scholars in the history and philosophy of science. Even historians of technology have been accused of underutilizing the evidence embodied in material objects (Corn 1996). The fundamental questions are not settled. First, there is no general agreement as to what counts as a scientific instrument: Are simulations instruments? Can people function as instruments? Do economic or sociological instruments operate in the same way as material instruments? There is a second, related debate about how scientific instruments work: Is there a unified account? Do instruments produce knowledge or produce effects? Do they extend our senses (Humphreys 2006) or embody knowledge (Baird 2006)? Third, HPS has seen a variety of approaches to fitting instruments into broader historical and philosophical questions about scientific communities and practices: Shapin and Schaffer (1985) relate instruments to the scientific life, Galison (1997) gives instrument makers equal footing with theorists and experimentalists within the trading zone of scientific discourse, and Hacking (1983) elevates instruments to central importance in the realism-antirealism debate. Finally, it seems plausible that there are methodological concerns specific to scientific instruments: What lessons can we draw from anthropology, material culture, and other allied fields?

I hardly need to emphasise that many instruments for medical and biomedical research fall into the category of ’scientific instruments’ — so, if you’ve got a good idea for a 1000-3000 word essay, don’t hesitate to send your submission before 26 February 2010.

For more details, see http://jps.library.utoronto.ca/index.php/SpontaneousGenerations