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Kathryn Baker

Closing the Circle: Community-Building at the Center for the History of Medicine, Harvard Medical School

1.         The Center for the History of Medicine

Collections

The Center is best known in research communities for its rich collection of medical incunabula--with over 800 books printed before 1501—European books printed from the sixteenth through the nineteenth century, and publications in English before 1800.  The Center also holds a comprehensive collection of American, particularly New England, medical imprints of the eighteenth and nineteenth centuries.

The Center’s fastest growing collections, however, are archives and manuscripts, now numbering between 15-20 million items, the largest collection of its kind in the United States.  The manuscripts collection includes the personal and professional records of physicians from the medieval and Renaissance periods through the twentieth century, including the professional papers of many renowned Harvard faculty members as well as physicians and scientists from New England and around the country. Notable collections include those of Alexander Leaf, Maxwell Finland, Henry Beecher, Walter Bradford Cannon, Benjamin Waterhouse and Nobel Laureates David Hubel, Bernard Lown, Thomas Weller, and Joseph Murray.

The Center maintains the archives of the Harvard Medical School (founded in 1782), School of Dental Medicine (1867), and School of Public Health (1922). The school Archives feature planning and policy records of the Deans' Offices, minutes of faculty committees, accreditation records, curricular materials, and departmental records of academic and administrative offices from the late 19th century to the present day.

Audiences

School administrators, people who create records and transfer into our care records of long term value, are a core audience for the Center, as are the donors of organizational archives and of personal and professional records, largely Harvard’s faculty members, physicians, scientists, and activists.

We also serve several groups that use records; these include faculty, students, staff and administrators from the Harvard schools and hospitals, and a variety of humanities scholars from Harvard University and local colleges and institutions, and the global scholarly community, particularly in the discipline of history.

Program development

In developing and executing programs for this complex audience of users and creators of records, we keep in mind Lorcan Dempsey’s maxim about “libraries in the flow”. Dempsey, Vice President and Chief Strategist for OCLC, has a popular blog in which he coined the term to means this: “the library needs to be in the user environment and not expect the user to find their way to the library environment”.

We put “archives in the flow” for records users by submitting our online finding aids to a web-based catalog that is accessed by search engines, digitizing historical photographs and creating online exhibits for the Center’s website. We also put archives in the workflows of administrators and faculty who create archival records and personal papers. We seek to demonstrate the relevance of historical materials to them and their work—and the relevance of their work to history. When records creators understand the long term value of their records, they may be more likely to preserve them, at least long enough to get them into our hands. In the case of email and other electronic records, the path from creation to disposition can be very short. The goal of this strategy is both richer holdings and broader use.

I use the phrase “closing the circle” to describe a set of activities intended to integrate our historical resources into the contemporary decision-making arena—to enable the past to inform the present and the future. Our underlying strategy is community-building—thus community is at the center of all that we do.
 

2.         The Archives for Women in Medicine (AWM)

The Archives for Women in Medicine is an example of this approach.

Background

In 2000, the Dean of the Medical School, Dr. Joseph Martin, asked the Joint Committee on the Status of Women, a formally-recognized group of women faculty and staff, to suggest activities to mark the new millennium. As JCSW members looked back at the past hundred years, they realized that evidence of women’s accomplishments—evidence of their presence at all-- was strangely absent from the school. Women scientists and physicians had served the school since the turn of the century, had been faculty members by the 1940s, enrolled as students shortly thereafter, with the first full professors appointed in the 1960’s. By 2000, women comprised 10% of tenured professors and 50% of the student body.

But, from a documentary point of view, they were invisible.

For example, campus buildings held dozens of portraits—with only one portrait of a woman among them, a painting of occupational health specialist Harriet Hardy that hung in a basement. Ironically, in the final chapter of her memoir, published in 1983, Hardy had written, “It has not been easy to find correct and interesting data on the early history of women in medicine.”

A JCSW member at the time, I remarked on the paucity of women’s collections in the Center’s holdings—of 900 or so faculty collections, fewer than 20 were created by women, and only one of these was processed and accessible for research. The JCSW had a strong and swift response: with the determined advocacy of its women faculty leaders, “The Archives for Women in Medicine”(AWM) was born.

The JCSW rapidly formed an AWM committee that had a single goal—to create a dynamic program, headed by an archivist, which would acquire, prepare for research access and publicize the personal and professional papers of women in medicine. It took as its slogan a pithy quote from contemporary historian Jill Lepore: “those who hold the evidence make the history”. To achieve its goal, the committee would first have to raise a considerable sum of money. Fundraising is relationship-building. Relationship-building is outreach— and the committee was ready to reach out.

It’s hard for me to express the passion that this project unleashed. To most of the participants, this was very recent history—they were preserving the lives of the generation of women who were their immediate mentors or their mentor’s role models. The project was intimately tied to their own identities. They knew what it was like to be disregarded, dismissed, de-valued, or their mentors did. They innately understood the value of capturing, preserving, and making accessible the evidence of accomplishment—and they had a sense of urgency about the project. Daily they saw familiar names on the rolls of retirees and the “Memorial Minutes”, the School’s tributes to professors who have passed away.

But they couldn’t fund the project alone—nor would that have been our chosen option. We wanted to communicate the value of the AWM—and the Center—to a larger audience.

Activities, 2000-2004

This was a great opportunity for dialogue. We distributed our images, slogan, text, and funding requests as broadly as possible. The Dean accepted our offer to write a paragraph for his 2001 annual report; the Registrar was delighted with the historical and contemporary photos we provided for the cover of the 2003 Course Catalog; and we were able to place articles in school and hospital publications.

In all these approaches, our message had a similar theme, although its form varied:

·In addressing senior women, we talked about celebrating achievement and preserving legacy.

·When talking to younger women, we encouraged them to consider their role models, how these people had influenced them, and the importance of preserving those voices for the next generation of physicians.

·With administrators we focused on the benefits of creating an inclusive culture where every community member will feel motivated to contribute fully.

·To department chairs, we pointed out the increasing number of women in the employment pool in medicine; to succeed, departments will be forced to compete for, and retain, the most talented women—and those who clearly value and celebrate women’s accomplishments will have an edge.

By 2004, more than 120 faculty members, including several department chairs, had made contributions. The Dean matched every gift, enabling us to fund a three-year documentation project.

Changing the Face of Medicine, 2005-2006

In spring 2005, we hired an archivist, Giordana Mecagni, and agreed to host a travelling exhibit, “Changing the Face of Medicine: Celebrating America’s Women Physicians”, the following year. The exhibit created by the National Library of Medicine, profiles outstanding women physicians from 1857 to the present.

Much of my time that year was spent working with 11 partnering organizations to plan and execute five events, showcasing 12 faculty women from eight affiliates and historians from three universities in the region.

Giordana analyzed potential audiences and built a database to track contacts with the hundreds of potentially interested community members. For the opening event, we invited every AWM donor, everyone we had contacted as a potential funder, all the senior women who we hoped might donate their papers one day, school administration, affiliated hospital CEOs, women faculty and medical students, as well as the gender studies and history of medicine and science faculty and students from local universities. For the first time, the Center intentionally invited those making history and those studying history to come together to exchange ideas and insights. For perhaps the first time, pioneering women could see their own history celebrated.

Anne Klibanski, a physician at the Massachusetts General Hospital, herself both the mentee of a groundbreaking physician and an energetic mentor herself, gave   introductory remarks at the opening reception, reminding participants that they, indeed, “stand on the shoulders of giants.”  After the event, she wrote,

It's difficult to know how personally meaningful an exhibit like this can be unless one is actually there…. after the introductions, so many women came up to me and just wanted to talk about historical changes in the role of women, and for the residents, students and fellows in particular, what the challenges are for the next generation of mentors and pioneers.

A clinical fellow who had wandered over from the hospital building adjacent to the library building mentioned how pleased she was with the library’s services. “Access to electronic journals changed my work, and I’m grateful.” She continued, “But it is events like these that change my life.”

We have since acquired the personal papers of three of the participating women faculty and have been contacted by five more. The publicity blitz associated with the exhibit and events had other results as well. It was clear to school leadership and to library administration that the AWM had an audience. Subsequently, the library embraced the project as a part of its programmatic commitment to the community.

Next round of fundraising: 2006-2007

At this point, halfway through the original AWM funding, we knew we needed to work quickly to make the AWM sustainable for the long term. Leveraging the excitement generated by “Changing the Face of Medicine”, the AWM committee set two targets: a gala event in fall 2007, to open the personal and professional records of Grete Lerner Bibring, the school’s first woman full professor, and to raise the funds needed to extend the project for an additional 18 months.

We fostered our community by creating a web-based newsletter, issuing email alerts with relevant news about AWM activities, current issues relating to contemporary women in medicine, professional development and historical events. Also, as some of our scientists weren’t entirely certain what an archives did, this newsletter sought to emphasize the kind of work we do, and what kind of records we were seeking to acquire. In every communication was an invitation to forward the email and join the AWM community. In this way, the AWM contacts database—all the people we had invited to the “Changing the Face” event—continued to grow. It now includes over 1,000 people, about 20% of who are historians or in other non-medicine academic fields.

Our annual appeal raised a modest amount of funds, but kept us visible and surfaced a small number of donors who were interested enough to give substantial amounts. Based on the principal that the people who benefit from a program are the people who are willing to support it, we continued to think about who we should approach for our next round of fundraising. The answer we kept coming back to was this: the biggest employers of women—this was not the school, but the five largest affiliated hospitals.

After seven years, AWM had a level of visibility and acceptance that played a role in our next fundraising success. Occasionally, a faculty member would introduce the topic by saying to me, “Have you heard about the Archives for Women in Medicine?” and go on to explain it to me. For some in the medical community, the AWM loomed much larger than the Center, or even the Library. Why? Because Giordana, in her role as the AWM archivist, had sought them out, communicated with them, asked for their opinions, made them feel central to the historical enterprise—and treated them as actors in their own histories.

Our incoming AWM committee faculty chair volunteered to ask the CEOs of the hospitals for a multi-year donation. To bolster our case, we spoke to each hospital’s success in advancing women, named women from that hospital whose papers we had already acquired, as well as those from whom we are currently seeking collections. We told them that this was important to the hospital’s future, as well as to its legacy: “The purpose is not just to preserve a history but also to encourage young women that they, like their predecessors, can aspire to leadership positions in medicine and biomedical sciences.”

We were astounded by the result. All five hospitals committed to join together to fund the project until 2011. The CEO of the largest hospital agreed to our proposal, saying, “This is an excellent project that highlights the wonderful contributions of women to the field of medicine. We are delighted to support this project….”

The new funding was announced at the opening of the Bibring papers in November 2007, to our growing community of AWM supporters and to special guests-- faculty, students, and administrators from the clinical psychiatry departments in affiliated hospitals.

The Bibring collection, though in demand, had lain unprocessed for many years. We were thrilled that Giordana was able to complete its processing and open it for research at last. A student of Freud’s and member of the Vienna Psychoanalytic Society, Bibring fled Vienna with the Freuds after the Nazi annexation of Austria in 1938.   She soon settled in Boston, working at the Simmons School of Social Work and at the Medical School.

In 1946, she was appointed chief of psychiatry at Boston’s Beth Israel Hospital, and in 1961 she became one of the first women physicians appointed to a full professorship at Harvard Medical School. Called the “doyenne of the Boston psychiatric community,” Bibring was president of the American Psychoanalytic Association and vice president of the International Psycho- Analytical Association. She was well-known for "The Pregnancy Project," a longitudinal research project on the psychological processes in pregnancy and of the earliest mother-child relationship

For the speaking program, Giordana selected panelists to represent various aspects of Bibring’s life – her roles as colleague, teacher, and clinician. In addition, we wanted the audience, made up of famous physicians, donors, and members of our affiliated communities, to understand the importance of maintaining records, and what an accomplishment it is to have the Bibring collection open and available.  To this end, we invited history of science scholar Margaret Rossiter to close the panel. Rossiter told a standing room-only crowd about her eureka moments in the manuscript collections of scientists. The scientists in the audience were encouraged to think of themselves as creators of history, and consider their papers as research resources, using the language of research methods and science that they all understood.

This summer, a private foundation will fund fellowships for historical researchers in the Archives’ new holdings. The work of fellows will provide examples the Archives will use in its acquisitions efforts with physicians and scientists, a demonstration of the value of personal and professional papers. One of the funded fellows will use the newly opened Bibring papers in her work on cultural conceptions of pregnancy.

In 2000, we had argued that without the evidence of women’s accomplishments in medicine and science, the history of medicine would not include the history of women in medicine. Eight short years later, the records are being used to write history. We hoped, but we could not have predicted this outcome.

What’s next for AWM?

Next month, Arizona State University Professor Monica Green will present “Why Women Can’t Be Doctors: the Medieval Origins of Women’s Marginal Status in Medicine”. Although Green will be lecturing at the University’s Medieval Studies department that week, we asked her to speak at the Countway as well. We know our community, largely busy clinicians, won’t travel across the city.  After all, historical perspectives aren’t just for historians.

Giordana is processing the papers of Dr. Mary Ellen Avery, a specialist in pulmonary disorders of the newborn infant. She was Physician-in-Chief of Children’s Hospital in Boston, from 1974 to 1985, and is a Presidential Medal of Honor Winner and a recent past president of the American Association for the Advancement of Science. A gala event will be held next spring to open the collection.

Our long term goal is to find the donor who is willing to endow the program… we’re still looking—and think our chances will increase with every year that goes by, as we expand our community and our relevance to them.


3.         Closing the Circle with other records creators and users

 What have we learned? And how are we using it? The concepts we’ve tested and the techniques we’ve learned can be readily employed in other aspects of the Center’s work.

For example, this past spring, to continue our message that history can inform the present and future, we worked with general collection librarians to highlight an area of growing interest to the School’s students and faculty, and to clinicians and patients: complementary and alternative medicine. We consulted with faculty of the Osher Institute, the School’s research division on complementary medicine, and with faculty of a nearby school of pharmacy, asking what would be of interest to them and their students and colleagues. Then we drew from the Center’s collections to create two exhibits, one on the early history of homeopathy in Boston from 1830 to 1900 and the other on masterworks in Chinese and botanical medicine, and developed a symposium, “Sectarian to Unorthodox to Alternative to Complementary Medicine: what historical perspectives can tell modern medicine”, that brought clinicians and historians together to place contemporary medicine in historical perspective, look at what has been contingent in medicine’s evolution, and critically evaluate today’s conceptions of health and health care.

We reached out with mailings, posters, and emails with posters, to many area organizations, and made sure that all the players were represented—from reiki practitioners and herbalists to hard-nosed biologists and pathologists.  At the close of the program, a reception brought participants together in conversation. One historian remarked: “you do this better than anybody. It is so important for medicine that physicians to see themselves as part of a historical tradition.”

As a result of the program, we’ve identified two faculty members whom we will approach to seek the donation of their personal and professional records. We’ve also been offered a collection of rare homeopathic medical journals and the archives of a regional association of practitioners of alternative medicine. .

The Center’s next project will focus on newly opened collections in reproductive health and rights, including Alan Guttmacher and Abraham Stone, early associates of Margaret Sanger and leaders of International Planned Parenthood, and John Rock, co-creator of the Birth Control Pill. This topical area touches on several disciplines and issues, including the science of reproduction, ethical issues, women’s rights, the history of obstetrics and gynecology, and legal issues. Because it is possible to take the program in many directions, we are now talking with physicians, scientists, and historians to see how they view these areas and what is of greatest interest to them. We’ll use this information to frame the exhibit and events in a ways that will be most relevant to them, their colleagues, and students. These conversations are a form of outreach – engaging them in program development – and relationship building. The Center has invited the general collections librarians to join us in these conversations, so they will include current as well as historical resources and concerns.

 The Center is now exploring how to replicate, expand, or adapt this model to further its goals in a variety of areas. Potential targets include the reinvigoration of its National Archives of Plastic Surgery, acquisitions efforts in HIV/AIDS and global health, and documentation of laboratory science, data sharing, and re-use.


4.         Conclusions

The Center for the History of Medicine was conceived as a source for rich and integrated collections in all formats; as a hub of dynamic programmatic activities; and as the locus for a community of records creators and users. To fully realize its goals of acquiring and providing access to unique resources that inform contemporary medicine and society, however, the Center has sought to enable the development of a synergistic science-humanities community through outreach, exhibits, and events.

Among the benefits of this work has been an increase in the donations of collections, funds and support, increased use of the Center’s holdings, and greater visibility which we hope will translate into creators’ willingness to maintain their electronic records long enough for us to acquire them. Clearly, our aim is to contribute to the school’s and University’s educational mission and obligation to benefit society at large.

But there may be unintended consequences as well.

Who knows about personal papers and archiving who didn’t before? Women faculty, male department chairs, CEOs, and colleagues of women faculty members, their families and friends, people outside the community. What will be the result of that knowledge?

Interestingly, three of the five major affiliated hospitals have recently reinvigorated their Archives programs. One has increased funding to support digitization of archival records; one is creating permanent exhibit for its hospital lobby, and one has embarked on a fundraising effort to construct a museum and archives. Have our efforts to close the circle with our extended community influenced their thinking?

We needed to reinvent the Center—acquire a growing of collections of personal papers still in the hands of retiring faculty members, alert younger people in the community about the value of their records, and demonstrate our value to potential funders. The Center was perhaps better known by the library and humanities research communities than by the school’s administration, faculty, and students.

The need to document the entry of women into (Harvard) medicine was a strategic opportunity to provide value— and make the Center relevant—to administrators, clinicians, and researchers in our community.

It has been said that humans constantly struggle to place themselves in context—thus have an innate historical sensibility. We have had no difficulty interesting people in their own past—the lives of their mentors and those people’s mentors, the development of their specialties, the history of their organizations…. What is more difficult is retaining their attention. We have tried to do that by giving them a sense of belonging to a community—and by demonstrating the usefulness of history in their daily lives.




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