When creating the concept for the exhibition Under the Skin, 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.
The ongoing importance of collections and collection practices thus means that:
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 was presented as a paper at the British Society of History of Science Annual Meeting 2014 in St. Andrews. It will also appear in a slightly different form in the volume: Tybjerg, K. (forthcoming in 2014) “From Bottled Babies to Biobanks: Anatomical Collections in the 21st Century” in The Fate of Anatomical Collections, R. Knoeff & R. Zwijnenberg (eds). Ashgate Press.
While Google has been doing a great job of their front page animations (today's is very nice, illustrating how Brazil and The Netherlands are on their way to Russia for 2018), Bing appears to be far more attentive to actually answering questions about the competition. For example:
Compared to Bing's
Google's answer brings up some interesting news articles, but Bing brings up stats on the teams and even a prediction of who will win (Cortana - which is driving these predictions - has been doing a perfect job of predicting game outcomes).
The forthcoming exhibition Under the Skin will display the heart blood of the medical museum – the anatomical and pathological specimens – as part of a longer history on the uses of human material in medicine leading up the biopsies and blood samples in biobanks.
The main exhibition principle is simple, instantly graspable and captures essential features of the historical development of medicine. Objects in the exhibition will be ordered according to scale ranging from the whole body to its molecules: Full skeletons and embryos, organs in glasses, biopsies, slices of tissue on slides, blood samples and DNA snips. The principle of scale draws on the materiality of the objects, but at the same time mirrors a shift in medical interest towards smaller and smaller units. Scale is:
The point of departure of the exhibition is the whole body, which was the main unit of medical investigation up to the 18th century. The whole body is, however, only present in the exhibition in the shape of the bodies of the visitors. The first objects exhibited are skeletons and foetuses. Although they are clearly recognizable to us as individuals, they already show the body as opened and divided.
Next step on the scale are the preserved organs. Anatomizing the body was the prevalent mode of investigation in the expanding pathological collections of the 19th century. Diseased organs were cut out and displayed together to form a new whole. They mapped out a landscape of malady where the individual body disappears. Disease was identified with the lesion and the preparations highlight it by isolating it from the rest of the body.
As microscopes allowed tissue and even cells to be studied we move from visible to invisible structures. Small lumps of tissue are prepared, sliced finely stained and studied through microscopes to show the cells of the body and possibly diseased changes. The exhibition shows both the biopsies and the structures revealed by the microscope thus bridging between the visible and invisible.
Research in the latter half of the 20th and into the 21st century has focused on the molecular level – the next level down the scale. Today large amounts of tissue and blood are gathered and stored in biobanks for investigations into the biochemistry of the body. Tiny blood samples taken from new-borns make it possible to investigate genetic and biochemical processes that make disease likely, and to diagnose before any symptoms appear.
At the end of the exhibition the individual body has been not just anatomized but atomized. Divided into immateriality and stored as information. In the code for DNA our individuality may be seen to re-emerge. The mapping of the genome in 2003 did not, however, provide a single key to understanding the body. Medical science still needs to investigate at the whole scale of the body as well as its interaction with the surrounding world. At the end, the visitor is – together with biomedical science – sent back through the scale in the never-ending process of understanding the human body.
The concept poses important questions:
Being a university museum, Medical Museion combines museum practice with research. But we don’t just conduct research on the specific content of our collections and exhibitions, we also engage in research projects on science communication and exhibition media. That is, research on how we interpret and communicate our objects through exhibition media, events, etc. In connection to the development of our forthcoming exhibition Under the Skin, I contribute to the museum’s research on exhibition media with a PhD project on exhibition design.
My PhD project focuses on the material encounter between exhibition object and museum visitor and how to ‘shape’ this encounter by use of spatial design strategies. In the exhibition Under the Skin the encounter between object and visitor is quite unusual, since it takes place between two bodies: the exhibited, medical body and the visitor’s body. Experimenting with what I call spatial-material design strategies, I investigate this ‘extreme case’ and, in close collaboration with the exhibition architect Mads Kjædegaard, try to develop ideas for displaying the human specimens.
For example I experiment with the idea of creating a ‘negative space’ that communicates both the physical shape of the object (the glass canister) as well as the overall idea of producing medical human specimens by extracting organs and tissue from the human body. By displaying the specimen in front of a plaster mould – the negative space of the object – the idea is to point towards this particular act of ‘excavating’ the body.
Another experiment evolves around the idea of ‘the medical gaze’ – the way the medical scientist uses the human specimen to zoom in on a specific lesion or condition. In this test display the objects have been placed behind a glass plate covered with semi transparent foil and with holes cut through it. The holes function as a sort of ‘framing’ of certain areas of the specimens and thereby direct attention towards specific material ‘attributes’. In this case, the massive blood clot in the heart specimen to the left and the delicate texture of the layer of fat covering the heart specimen to the right. Also, the semi transparent foil in some ways resembles human skin, and the cut outs thereby relate to the concept of medical dissection.
By working very intentionally with these kinds of display techniques we wish to create an exhibition that on one hand communicates the scientific, medical gaze on the human body, while at the same time makes it possible for the visitor to connect to the bodies on display in a very immediate and materially embedded way.
These are just a few notes on the design experiments and test displays intended to inspire and inform the overall design of our forthcoming exhibition. More will follow as the project develops.
Revised notes for remarks I delivered on the topic of “Tools: Encouraging Innovation” at the Institute of Museum and Library Services (IMLS) National Digital Platform summit last month at the New York Public Library.
What do we mean when we talk about innovation? To me innovation implies not just the “new” but the “useful.” And not just the “useful” but the “implemented” and the “used.” Used, that is, by others.
If a tool stays in house, in just the one place where it was developed, it may be new and it may be interesting—let’s say “inventive”—but it is not “innovative.” Other terms we use in this context—”ground breaking” and “cutting edge,” for example—share this meaning. Ground is broken for others to build upon. The cutting edge preceeds the rest of the blade.
The IMLS program that has been charged and most generously endowed with encouraging innovation in the digital realm is the National Leadership Grants: Advancing Digital Resources program. The idea that innovation is tied to use is implicit in the title of the program: the word “leadership” implies a “following.” It implies that the digital resources that the program advances will be examples to the field to be followed widely, that the people who receive the grants will become leaders and gain followers, that the projects supported by the program will be implemented and used.
This is going to be difficult to say in present company, because I am a huge admirer of the NLG program and its staff of program officers. I am also an extremely grateful recipeint of its funds. Nevertheless, in my estimation as an observer of the program, a panelist, and an adwardee, the program has too often fallen short in this regard: it has supported a multitude of new and incredibly inventive work, but that work has too rarely been taken up by colleagues outside of the originating institution. The projects the NLG program has spawned have been creative, exciting, and new, but they have too rarely been truly innovative. This is to say that the ratio of “leaders” to “followers” is out of whack. A model that’s not taken up by others is no model at all.
I would suggest two related remedies for the Leadership Grants’ lack of followers:
These are anecdotal impressions, but it is my belief that the NLG program could be usefully reformed by a more laser-like focus on these and other uptake and go-to-market strategies in the guidelines and evaluation criteria for proposals. In recent years, a higher and higher premium has been placed on sustainability in the guidelines. I believe the effort we require applicants to spend crafting sustainability plans and grantees to spend implementing them would be better spent on outreach—on sales. The greatest guarantor of sustainiability is use. When things are used they are sustained. When things become so widely implemented that the field can’t do without them, they are sustained. Like the banks, tools and platforms that become too big to fail are sustained. Sustainability is very simply a fuction of use, and we should recognize this in allocating scare energies and resources.