The Smithsonian Institution’s National Museum of American History is tasked with collecting the history of medicine and in particular the medical heritage of the United States. Yet, the increasingly fast paced world of current medical technology provides museums with a variety of challenging dilemmas.

Compared to steel blades and ivory handled surgical instruments of centuries past, contemporary medical science and technology is often perceived as a series of “large black boxes”; not very compelling and difficult to explain to museum visitors. As technology becomes larger and sometimes smaller, the never ending quest to find space to store new acquisitions and how to exhibit nano particles are ongoing issues.

Whether a medical museum is part of a university like the Medical Museum here at the University of Copenhagen, a collection within a larger museum complex such as the Smithsonian’s National Museum of American History, or a stand-alone museum such as Museum Boerhaave in Leiden, we all share the same concerns and issues about collecting contemporary medical science and technology.

A cursory look at the literature of collecting for museums reveals a fair amount has been written on the subject. It is however frustrating that most of the essays and monographs focus almost exclusively on the collecting philosophies within the disciplines of the decorative arts or natural history. Only occasionally are medical and technological artifacts specifically discussed. Over the years medical history curators have created a vocabulary and nomenclature to with the disciplines own unique requirements and terminology.

We are also confronted with an interesting collecting juxtaposition. Much of the big bulky diagnostic and gene altering equipment of the late twentieth century has been created to manipulate some of the smallest known particles and turn them in to life saving therapies. Large artifacts take up space and nano-medicine is just on the threshold of becoming reality. Aside from following the latest scientific news releases we are left to guess which medical breakthroughs will change the direction of medicine and alter future technologies which may or may not become standard treatments. As we acquire new artifacts how do we know what we are collecting today will be historically significant ten or twenty years from now?

This presentation begins by discussing some of the collecting issues all medical museums are confronted with as we head further into the twenty-first century. Next will be a review of some the collecting techniques we have found useful at the Smithsonian and, finally I will argue that there are many compelling contemporary collecting opportunities and not all of them are black boxes.

Collecting challenges:
* Experimental equipment seldom is saved for posterity, more often than not it is thrown away or it is cannibalized for the next prototype. One of the great loses to medical history is John Gibbon’s original heart lung-machine. Gibbons and his team dismantled the original to make another heart-lung machine. Recently I spoke with Dr. William DeVries, the heart surgeon who implanted the first permanent artificial heart. DeVries confessed in the aftermath of the emotionally charged and physically grueling 112 days of Barney Clark’s, he burned the diary he had been keeping of Clark’s life as the first human to receive a total artificial heart, the surgical team and the media circus surrounding the entire event. While the circumstances were different both acts were deliberate and the outcome is the loss of significant moments in the history of cardiology.

Inventors simply do not always think to save prototypes or documentation which might demonstrate the development or the thought process behind the invention. Perhaps even more disconcerting is the disinterest among some in the medical community to their own history.

* The advent of disposable medical equipment in the 1960’s and 1970’s made from flimsy material, pharmaceuticals with precise expiration dates, paper examination gowns that do not hold up through an entire examination volumes about the state of medicine, the economy, the environment and society in the United States during this period of time. Use something once such as a syringe and the object gets throw away. There is a vast difference between your Great Grandmother’ ceramic bedpan and the blue plastic one-patient disposable kind found in today’s hospitals.

* Inherent vices, the deterioration of material due to the instability of the very materials an object is made from; materials the medical world depends on for any number of reasons, such as plastic and rubber, cause innumerable conservation problems.

Ordinary and not so ordinary medical equipment such as cannula, hearing aids, eyeglasses or the transport carrier of David the Bubble Boy are doomed from the moment of their creation. Isolating these objects in a sterile temperature and humidity controlled environment which may or may not preserve them is beyond impractical. Plastics and rubber either become sticky, develop a white-powder substance or become brittle and harden into fossils. Should we be collecting objects which have such a short shelf life? Should we collect artifacts which are in such bad shape it would take thousands of dollars to make them ready for exhibition? What is the cost to the other objects in the collection?

* Collecting from corporations and living donors present different challenges and difficulties when trying to collect contemporary medical science and technology. Differences between the goals and expectations of the donor and those of the can and often do create conflicts of interest. The exhibition of a single object from a major corporation is often construed as nothing short of free advertising for the company. The donor may want to put restrictions on the gift or see the donation as an opportunity to participate in the intellectual content of the exhibition. Most donor’s corporations or individuals are thrilled to have their objects accepted for donation. Yet there are those who want to dictate the terms of the loan and how its history is recorded.

* One of the most common issues museums confront when collecting contemporary medical technology is the black box syndrome. The standard complaint for several decades now has been that the black box with its ubiquitous, square-shaped, nondescript switches, wires, plastic, circuitry and micro chips are difficult to interpret and esthetically unappealing to the casual museum visitor. Indeed, this is often the case. Our challenge is to find ways in which to make these devices more interesting. Perhaps the answer lies in the way we collect artifacts.

Then there is the dilemma of size which in fact is hardly a new issue, but perhaps one of the greatest obstacles we face. The search for more space to store objects is constant. We never seem to have enough space for our collections or the expansion of collections.

As we are all aware prototypes tend to start out life larger than its progeny. Electrocardiograms are a classic example of medical instrumentation shrinking in size over successive decades. A contemporary example is the blood cell separator used for the separation of human blood cells from patients to donors. The Smithsonian has several examples of cell separators which document the evolution from the first commercial unit built in 1969, to the machine used in the first gene therapy experiment and subsequently to a small blue enameled steel tabletop model manufactured in 1973 the Fenwal Company by the American Instrument Division of Baxter-Travenol.

Even if all museums had ample space, the funds to properly take care of objects are most likely not available. Building new storage facilities or renting warehouse space is extremely costly. We have to ask ourselves, why are we collecting this particular object, and is it worth collecting?

Collecting Experiences:
So how do make the most responsible collecting decisions? Within a museum setting collecting artifacts is an evolving process where collecting philosophies can change as well as its mission to reflect contemporary goals. This was the case in 1981, when the National Museum of History and Technology changed its name to the National Museum of American History. The focus of the museum became cultural rather than technological. The Division of Medicine also changed its focus to concentrate almost exclusively on the history of American medicine.

During this same period the medical collections began to change the way it acquired artifacts from the wholesale collecting of everything that came its way to greater selectivity and more thoughtful collecting practices. This is clearly reflected in two different decades separated by twenty years. In the ten year period between 1980 and 1989, the medical collections acquired approximately 57 acquisitions per year. In contrast, only 20 acquisitions per year were acquired between the years 2000 to 2009. Not surprisingly, these figures directly correlate to the acquisition activity of the NMAH during the same two periods.

We acquire artifacts in a variety of ways; the most common being passive collecting. The majority of artifacts find their way into the collections when donors make contact with the museum usually through a telephone call or email. There are those occasions when artifacts are actively sought out for an exhibition or a specific collecting initiative. Yet, another avenue for collecting comes from thoughtful colleagues who have donated various items including trifocal lenses, an artificial hip, wigs, dentures, a knee brace and this custom made plastic helmet for infants who have developed palgiocepaly (misshapen head) while sleeping on their backs.

Collaboration: Ways to go about collecting: Small Beginnings / Project Bionics
There are collecting initiatives which require more thought and a great deal more work on the part of the curator. The following examples are a collecting model which is more structured and has proven to be very successful and enormously satisfying.

This first example is a small finite collection of artifacts which are not terribly glamorous but an important component of medical history in the past thirty years. In 2006, a cross-unit museum team traveled to Southern California to document the inventions of Sharon Rogone, a determined neonatal nurse turned inventor and entrepreneur whose company Small Beginnings was created to fill a special niche for the hospitals tiniest patients.

The team of three included a historian of medicine, an archivist and a historian of invention whose goal was to collect artifacts and archival material related to Rogone’s company. Founded in 1998, Small Beginnings manufactures phototherapy masks, drainage tubes and pacifiers for premature infants. Our goal was to collect and document the artifacts of a woman inventor, her struggles with the invention and patenting processes through production and distribution. In addition we were able to collect contracts with distributors, product advertisement, patent and trademark files. Lastly we conducted oral interviews with Ragone and two of her partners trying to capture the invention process and the culture of the NICU.

PROJECT BIONICS:
The second example is Project Bionics. Established in 1998, Project Bionics, was a collaborative venture comprised of three disparate organizations, the Smithsonian’s Division of Medicine and Science, the Division of History of the National Library of Medicine and the American Society of Artificial Internal Organs which came together to preserve the history of artificial organs. The collaboration brought together an interesting group of stake holders, historians, archivists, physicians, engineers and scientists whose goal was to collect and preserve the history of artificial organs and their documentation.

Since its beginning Project Bionics has acquired some of the most significant artifacts and archival material documenting the history of artificial organs. The artifacts include artificial hearts and assist devices, kidneys, heart-lung machines, and a prototype artificial lung. The documents most of which reside in the Archives of the National Library of Medicine include documents and interviews pioneer inventors, surgeons and scientists including Willim Kolff, Adrian Kantrowitz, Robert Jarvik, Clarence Dennis, John Watson and most recently William DeVries.

We conscientiously strove to capture as many aspects of the artificial organ program in the United States to including invention, surgery manufacturing as well as the impact of the sensational procedure as it relates to the patients.

Additionally Project Bionics published a listing of artificial organ collections housed in museums in the United States, Europe and Japan. Besides the limited bound edition the list can be found online at the History Division of the National Library of Medicine.

Conclusion:
The types of artifacts we collect and the way in which we collect has indeed changed but one constant theme has prevailed, collecting contemporary medical technology is not new to the Smithsonian Institution. From its inception more than 100 years ago, the curators of the Medical Collections have actively sought out and collected cutting edge medicine.

The National Museum of American History chooses to collect the history of medicine and in particular America’s medical heritage, however, we cannot collect everything nor is it necessary we do so. As collecting policies have changed curators have become more discerning in what we acquire. The medical collection does not need one of everything. Nor is it necessary acquire everything that is offered for donation. Gone are the days of acquiring entire collections acquired by a single individual which may possibly show historical chronology but often lacks historical and intellectual content. It is far more important to selectively acquire objects which document the historical significance of medical technology. Large black boxes cannot simply be ignored. It could be argued that Claude Beck’s prototype defibrillator, a wooden box with a simple on–off light switch is the 1947 version of the black box. Who is to say that the objects we consider today to be black boxes may one day in fact be the curiosities of the future.

Our challenge lies in thinking creatively about what it is we are collecting and to find complimentary artifacts to enhance the black box which seems to have stifled curators. If an artifact is historically important and therefore worth collecting, no matter how esthetically unpleasing we as museum professionals should make every effort to find a way for that artifact to be preserved.

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