History of health, medicine and naval history
What is the public perception of an archivist? A dynamic and efficient information and records manager contributing to the information demands of the organisation for which he or she works, a facilitator for researchers, a sort of librarian, an educator, an historian, a fount of all knowledge – or just someone who looks after anything that is old and dusty? We are all familiar with the assumption that because we deal with ‘old papers’, then we must be interested in anything of any assumed antiquity. After all if it is old, it must be interesting – at least to the archivist! All archives must at some time have been offered artefacts for their collections from depositors who see archives as merely historical resources housing any historical material in any format and do not see any difference between different types of historical evidence. It is old, therefore your responsibility. Examples from my own collections at St Mary’s Hospital, Paddington, London, include microscopes, lecturers’ chairs, penicillium mould medallions given by Fleming to his admirers and germ paintings coloured with different pigmented bacteria. In most cases the archivist suggests a better place of deposit and finds a suitable home for the object, often relieved at not having to find room for an early electrocardiograph machine or iron lung which are more appropriately housed in a large science or medical history museum rather than an institution which happened to use them.
But what about objects that are in some ways unique to a particular institution and part of the history of that organisation which it is the role of the archive to document? Such items may even include chamber pots bearing the Hospital crest. Hilary Jenkinson in his classic manual of archive administration that once defined British archival practice, raised the question as to whether an elephant could be considered an archive. We might conclude that an elephant sent as a diplomatic gift should not be in an archive but the accompanying documentation should. However, should an example of a nurses’s uniform that was distinctive garb for the staff of a particular hospital be included in the archives? The general public, seeing the issue in holistic terms, would say ‘yes’. The archive professional might well hesitate and then take in to custody the objects rather than see them otherwise lost or destroyed. In many institutions, the lone archivist has to take on the role of the heritage manager and not only care for the archives but also for collections of portraits, works of art, historical books, museum objects and much else. Cross-domain working was essential even before it became a fashionable buzzword. The difference from current theories of cross-sectoral co-operation is that one department or even one person was doing it all alone – not as an archivist co-operating with colleagues in libraries and museum, but as an archivist trying to carry out duties more appropriate to his or her colleagues in the other two sectors.
Archivists working in the British National Health Service have often taken on the dual role of archivist and museum curator. Employed to set up or manage an archive service, they have often, willingly or unwillingly, found themselves faced with collections of objects that are their responsibility, either by default or included within their job descriptions. When I started at St Mary’s Hospital in 1989, employed to establish a completely new archives service, my job description included mention of ‘curatorship of archaeological finds’. Curious about this, since St Mary’s was a nineteenth-century foundation on a site that had previously been open fields, I asked what they were only to be told that the job description had been copied from that of the archivist at St Bartholomew’s Hospital where there had been excavations of a site occupied since Roman times. I should point out that my current job description more closely reflects what I actually do but it also explicitly lays out my role as being both archivist and museum curator, since, like many other National Health Service archivists in London, I am responsible not only for archives but also for managing a museum within the hospital.
Many London hospitals which have employed archivists have made the move from holding a passive collection of museum objects within the archives stores, suitable for supplementing the archive material displayed in permanent or temporary exhibitions throughout the hospital, to actually establishing proper museums open to the public. Such museums form a public relations function for the hospital trust and stress the venerability of the organization and the service it has offered, and continues to offer, to the promotion of healthcare. In all cases, the hospitals which tend to establish archives and museums are teaching hospitals which when the National Health Service was set up in 1948 were allowed to retain their endowment funds from their days as voluntary hospitals, independent charities. These charitable funds are now controlled by independent charities appointed by the Secretary of State for Health and use their income for the benefit of the patients and staff of their associated hospitals. Preserving the historical legacy of the institution is within the remit of these charities. The charitable trustees are able to invest money in archives and museums that a cash-strapped National Health Service is often unable to do. Imagine the outcry if the public thought that hip operations were being cancelled because money was being used to pay for the cataloguing of historical records. Links with universities as teaching hospitals also mean that there are other funding sources available from higher education. This availability of ‘soft’ money has often enabled museums to be added to the archives service, as the following examples will show.
St Bartholomew’s Hospital, as befitting London’s oldest hospital founded in 1123, has had an archivist, not at first always a qualified professional, since the 1930s. In that time, the archives acquired a large collection of objects but it was not until the late 1990s that a museum was set up. One of the major motives in establishing a museum was the opportunity to display some of the more interesting and unusual items in the care of the archives that would otherwise languish unseen in storage. Displays, by telling the story of St Bartholomew’s, would open up the context in which the archives should be seen and perhaps encourage more people to understand the work of the archives a concern for the current archivist Samantha Farhall who declares herself ‘a firm believer in enabling people to experience the real thing’. The museum also offers patients and their relatives an opportunity in visiting the exhibition to escape from the more worrying reasons why they are in the hospital. For the management there was also the consideration that the displays would offer to the public a positive image of the work of the Hospital after a period when its very existence had been under threat and there had even been talk that the historic buildings might be suitably reused to house a museum of British national history, an idea which has not come to fruition.
Perhaps an unstated reason for opening a museum at St Bartholomew’s at that time was that the hospital had recently merged with the Royal London Hospital in Whitechapel and the Royal London, a late-comer, only having been founded in 1740, compared with St Bartholomew’s, already had a museum of its own. This museum, opened in 1991 when the Royal London Hospital was celebrating its two hundred and fiftieth anniversary, too had its origins in an archive service set up at the hospital in the 1980s. It is housed in the crypt of a nineteenth-century church, which also accommodates the library of the School of Medicine and Dentistry and also partly acts as a local museum in that it tells not only the story of what was once Britain’s largest general hospital but also that of healthcare in the east end of London in which it is located.
The development of the archives and museum at the Bethlem Royal Hospital, a psychiatric hospital founded in 1247 also had its origins in the collections of artefacts and works of art that came to light after the appointment of a professional archivist in 1967. Many of the patients were artists of the stature of Richard Dadd and Louis Wain, famed for his cat paintings, and these works of art formed the nucleus of museum displays set up by Patricia Alldredge next to the archives housed in a pavilion in the hospital grounds. In time the Hospital management came to feel that the archives and museum might more appropriately be governed by an independent charitable trust rather than remain under its control. The Bethlem Art and History Collections Trust was established in 1992 and over the years the relationship between the Collections Trust and the parent National Health Service Trust became more remote and the Archives and Museum, still linked together, became totally independent. An annual grant continues to be paid from the charitable funds of the Hospital in return for archives, records management, education and museum services. The former head of the service, Michael Phillips came from a museums background in succession to a professional archivist. It is his belief that independence from the National Health Service has been beneficial:
‘Once this small organisation was allowed to become independently accountable with the right mix of skills both in its governing body and in its staff it has been able to provide a very much better service both for the hospitals that fund it and for the general public.’
By contrast to the museums that have grown out of archives services at other London hospitals, the reverse happened at Great Ormond Street Children’s Hospital where a museum spawned an archives service and it is now an archivist who, as elsewhere, leads the museum. In 1978 the Medical Illustration Department there marked the supposed centenary of nurse training at Great Ormond Street with a temporary exhibition, which, like many such temporary displays, became semi-permanent. By the late 1980s, a more permanent museum was set up in a Georgian house opposite the main hospital buildings with the now retired director of Medical Illustration as part-time curator for two days a week. Although not a museum professional, he had many of the transferable skills necessary for such a role, especially in the area of displays. Working closely alongside him was an honorary archivist, who realised that there was a pressing need for a more professional input into the archives. Together with the curator of the museum, he persuaded the hospital to employ an archivist in 1990. Once someone with the requisite professional skills and qualifications was in post, it was possible for the archives to be brought together after a chequered existence in which they had been housed in some squalor in a disused furniture factory, a former stable block and a converted sewing machine factory. When the museum curator retired in 2000, there was no question of employing a museum professional and management of the museum fell by default to the current archivist, Nicholas Baldwin who believes that ‘the set-up works reasonably well at present, so long as the archives are not moved off-site, and we can combine both functions with relatively little logistical strain’.
The Museums that we have so far looked at are all essentially institutional museums devoted to the history of their particular parent organization, although their individual slants give most of them a wider significance than the purely local. The ultimate aim at Bethlem is to expand the displays into a Museum of the Mind, but so far this has not materialised. My final example is of a museum that is not concerned with institutional history but with a significant medical advance associated with the hospital it is located at. The Alexander Fleming Laboratory Museum at St Mary’s Hospital, Paddington, is concerned with the history and development of penicillin and is centred on a reconstruction of the laboratory in the exact room in which Fleming made his discovery in 1928. This emphasis gives it a more international and less institution-centred profile than some of the other hospital-based museums in London, though like them it is still very site-specific.
I was appointed as archivist to St Mary’s at a time when the Hospital and its associated medical school were going through a period of change and there was perhaps a need to find security in a sense of identity rooted in the past. The Hospital was going through the trauma of National Health Service reorganisation and its associated medical school faced obliviation following its incorporation into Imperial College. My brief was to establish a new archive service for the hospital, its associated but independent medical school and its smaller constituent hospitals which had once been independent but were now part of the teaching group. Inevitably, in the absence of anyone else, I assumed responsibility for anything and everything connected with the heritage of the hospital including the setting up of the Fleming Museum, which capitalised on St Mary’s Hospital’s greatest claim to fame, the discovery of penicillin. The Museum opened in 1993 with funding from the pharmaceutical giant SmithKline Beecham (now Glaxo SmithKline), one of the beneficiaries of penicillin, and aimed to further the public perception and understanding of science and the history of medicine. It is staffed by a team of volunteer guides on a daily basis, a number of whom have worked in the Museum since it first opened and bring a dedication to their role. Relying on such volunteers, though, can have drawbacks however essential this may be when funds are limited and paid staff few in number. I have been successful in raising funds for a professionally-qualified assistant archivist to aid me at various periods but funding for such posts from external charitable sources is inevitably short-term and often with specific archive cataloguing projects as their specific aim, whereas the volunteers have tended to offer their services freely on a long-term basis. Volunteers, many of them elderly, do need a great deal of support and encouragement which is time-consuming for the hard-pressed archivist and curator but if inspired by good leadership can offer a loyalty and commitment that goes beyond the cash relationship of employer and employee.
With such aims of furthering public awareness of the history of medicine, there are innumerable advantages to having a museum attached to an archive. Generally museums are more visible and seen as ‘sexier’ and having more immediate appeal, whereas a specialist archive can be seen only too often as appealing more to serious scholars, despite the increasing use made of them by genealogists seeking information on ancestors who were patients or staff let alone the countless enquiries from people seeking their exact times of birth for astrological purposes. Yet, archives still seem more serious, more academic and demanding of harder work. Archivists these days are themselves more aware of the importance of displays as part of their outreach work, so there is already overlap. An attached museum by its very visibility and the fact that people can easily understand its purpose can further raise the profile of an archives service and make it more glamorous so as to attract the attention of hospital management. By providing measurable visitor figures that are inevitably far greater than those for visits to a small, specialised archive repository, a museum can prove a useful tool that the archivist can use to justify his or her existence. .
There are also great advantages to combining archive and museum collections when approaching outreach activities. Artefacts and archives together can really grab the attention of an audience. In my own role at St Mary’s Hospital, outreach work is considered important. I give presentations to individual departments on the history of their specialties and the development of those departments in order to give some historical context to the work of these health professionals that goes beyond their immediate day-to-day concerns. In giving lectures at student nurse inductions, my aim is to give some sense of the history of the institution to which they are coming to work and some insight into the development of their professional status. Such presentations are probably light relief after much more medically and work –orientated topics. I also give presentations in the Museum to a wide variety of school, university and leisure groups and also go out to them at their own venues. St Mary’s is aware of the importance of inspiring the doctors and nurses of the future and it is possible that in the long term a memory of an interesting presentation might just help to rouse an interest in medicine or nursing as a career in some school student. Some American universities bring their students year after year if they have London-based semesters. All of this is good public relations for St Mary’s NHS Trust, widens the educational role of the archives service within a teaching hospital and gets our collections more widely known and used. In all of this, the starting point comes from the extensive collection of museum artefacts and associated archive collections, since the object of any such educational programme must be based on its collections, its unique selling point. The biggest outlay is actually in staff time. What matters even more is staff enthusiasm to bring history to life.
All of this cross-sectoral working very much fits in to the British Government agenda for libraries, archives and museums. Much of the work involved is seen as being involved with heritage management rather than with the skills and expertise specific to the archives or museums professions. At St Bartholomew’s, Samantha Farhall feels strongly that ‘the “heritage” tag is detrimental and to be avoided at all costs’, but she often feels ‘like the caretaker of a historic house/facilities manager, rather than either an archivist or museum professional’ because she has responsibility for all the art work and furniture within the eighteenth-century North Wing with its Hogarth murals. In all such cases what is needed is what Neil Handley, Curator of the British Optical Association Museum describes as ‘an acute sense of theatre and understanding of the “visitor experience’”’ which is essential in any form of public presentation, be it archive or museum in origin. There is often something of the actor in anyone undertaking any form of public communication in order to grab the attention of the audience. It is not enough having something interesting to say if the delivery does not bring it alive. A lively, humorous approach can pay dividends. I often begin presentations to schools on the importance of Fleming’s discovery of penicillin by conducting a mock auction of one of the mould medallions he gave as thank you gifts to such luminaries as Queen Elisabeth of the Belgians and Prince Charles of Belgium in 1945 in return for the bestowal of an honour. I then ask them how much a modern vial of penicillin is worth when considering the countless lives saved by penicillin. Sometimes the students think that this is a continuation of the bidding in th mock auction, but the more thoughtful ones quickly realise that the answer is that the drug is priceless since no monetary worth can be placed on life itself. Once the ice has been broken and the attention of the audience gripped in the first few minutes the rest of the performance must live up to those expectations but is perhaps easier thereon.
However, some of the very advantages of a combined archive and museum service can simultaneously be serious disadvantages. It is all too easy for people within the Trust to confuse the roles of the archives and museum, often placing much more emphasis on the museum side of things as being much more visible. This creates a danger that some of the seemingly less glamorous aspects of archives are downgraded and even ignored. At Great Ormond Street, Nicholas Baldwin is concerned that ‘the combination of archives and museum is probably not conducive to Hospital managers’ perception of us as having a meaningful role in the records management side of things’. He was removed from the Trust’s Medical Records Committee when it became the Electronic Records committee, although at such a time of change in the management of health records the input of the archivist is even more crucial. In many British hospitals, records management tends to be done, if at all, at departmental level. At St Mary’s, my own role in records management has been confined to producing overall records retention policies and advising departments if called in when they have a problem. In terms of time and resources, managing an archive and a museum services means that it is just as well I do not have any wider records management responsibilities than that, although they are needed. I am certainly not a superman, however much the public and fellow staff may sometimes expect the archivist to be fount of all knowledge and to sometimes do the impossible. At St Bartholomew’s and the Royal London, there is a separate Trust-wide records manager, which makes life easier, though even there museum duties often prevent the archivists from undertaking the more complex cataloguing projects that they should be involved with.
Most archivists running museum services as part of their remit actually enjoy the overlap of their duties between the archives and museum sectors and would wish to keep control of a joint service, as the different approaches demanded of a museum curator are stimulating and add variety. At the same time, the addition of a dedicated, qualified museum professional to the team would be welcomed. That is in the ideal world. In the real world, it is very unlikely that an additional post would be funded. Indeed there might not be enough work to do at either St Bartholomew’s or Great Ormond Street where the displays are static. Archivists running museums are well aware that their professional training does not cover the conservation or cataloguing of objects nor the theory behind their interpretation and display and it is possible that this lack of museum training can prevent a museum from attaining its full potential. The Bethlem Museum doubled its visitor figures from 1,000 to 2,000 visitors a year when it appointed its first museum professional and extended its outreach work through another dedicated member of staff, releasing its archivist to concentrate on his archive duties. Yet, many of the skills needed are transferable and there are sources of advice readily available. Certainly the public does not care whether a museum is staffed by an archivist or museum curator. All that matters is whether the museum is good or not.
Networks provide good support to the archivist stepping beyond his or her professional parameters into the museums world. The Health Archives and Records Group provides a forum for the discussion of professional issues concerning archives and records management in a health, medicine and hospital context, while the London Museums of Health and Medicine supplies an unrivalled resource of expertise, support and guidance on medical collections and museums issues. The dominance that London has maintained over medicine in England means that the capital contains a plethora of medical museums, many of which are archivist-led. It is significant that in the years since the group was formed in 1991, two of its seven chairmen to date (including myself) have been professionally trained archivists yet have led a museums-orientated group. For the purposes of that group, the archivists, who have to straddle the professional boundaries of two disciplines, are accepted as fellow curators by their museum professional colleagues. It bodes well for future cross-sectoral collaboration, but there still remains a need for separate forums for the discussion of issues that are unique to each area. It is also significant that so far there is perhaps more collaboration between the archives and museum professionals than with medical librarians, whose concerns are less with heritage than with current medical and nursing educational needs. There is also often less interplay between archivists and the people involved in managing current medical records than is desirable with the archivist being seen as responsible for older bound volumes while the current files are the province of the health records manager.
Most archivists in charge of medical museums would argue that they are doing a competent job, but the question remains as to whether such medical archives and museum collections are best served by an archivist taking responsibility for museum collections. Certainly, when looked at from the other direction and asking the question whether we would be happy for hospital archives to be led by a museum professional, we get a different picture. Most archivists have seen too much of the intellectual and physical damage done to archives by well-meaning amateurs to be happy about a non-archivist acting as an archivist. By training, we are aware of the importance of hierarchical cataloguing, original order and the administrative history of a collection but the non-professional archivist is unlikely to understand any of this. But perhaps with the right instruction and guidance, the museum curator can make the intellectual leap just as archivists acting as museum curators must do if they are to be as successful and effective in the very different museums discipline. After all, museum professionals too are wary of what they also perceive as uninformed intervention by amateurs. The danger comes when, from whatever background, we are unaware of the differences in the two approaches. Thankfully, most archivists in the National Health Service are flexible and able to move between the two worlds, sometimes even going native in the process and being accepted as a curator by curators.
In the world of poorly funded heritage services in larger organisations whose priority is healthcare, the archivist through circumstances has taken on a wider role and often become a museum curator as well. If he or she had not done so, valuable collections might well have been lost and our heritage would be poorer. It doesn’t need for the archivist to be a super being in order to do so. Much of it comes down to common sense and flexibility in understanding and embracing a different discipline without too much of a blurring of disciplinary boundaries. Flexibility and adaptability, as well as multi-skilling are likely to be the even more essential in the future than they are now. The National Health Service gets a good deal out of all of this in getting two for one if the archivist also manages a museum service. The archivist gets the intellectual stimulation of taking on new skills and working in a new but related professional field. The increasingly discerning and demanding public are generally happy with the combined museum and heritage services they thus receive, and it is the provision of a good public service to the highest possible professional standards that ultimately matters.
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