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Olof Ljungström and Daniel Normark

Overcoming the amnesia of modern biomedicine? Outlining a "historiographic agnatology

“…one generation’s conscious omission, is the next generations genuine amnesia.”[1]

 

Introduction

In 2005, five years before Karolinska Institutet Medical University’s (KI) 2010 bicentenary, a project was launched to reintroduce history of medicine to the institute, and in so doing among other things also create an archive of sources to the history of modern biomedicine. Halfway through, with both backlashes and temporary dispositions, we have been forced to re-examine the purpose of our reintroduction of this historical discipline at the medical university. This paper presents not only the current project for an archive of sources to the modern history of medical research at the KI, but also attempts to detail aspects of an institutional “culture of history” salient for our efforts.

It should be noted that the authors of this paper are not professional archivists, but academic researchers. Olof Ljungström holds a Ph D. in the history of science from Uppsala University, while Daniel Normark holds a PhD. in the sociology of technology from the University of Gothenburg. The project to establish an archive for the history of modern medical research at the KI grew out of a researcher’s recognition of the unequivocal need for well-managed documentation and archiving of the sources of history.

The aim of this paper is two-fold; initially it describes an ongoing project, the “Archive for the History of Medicine” (2007-2008), presenting its motives and providing a current progress report; the project, however, also works methodologically as a breaching experiment, bringing to the forefront culturally taken-for-granted patterns within KI that we hope to outline. We tentatively argue that a “historiographic agnatology” can be discerned, inhibiting the maintenance and utilisation of archives of the history of medicine. This “agnatology” seem likely to need to be actively addressed in order to successfully conclude, as we hope, the process to establish centre for the history of medicine at the KI.

Working for the future proof of Swedish medical research

Research into the history of medicine in Sweden

As stated a major reason for attempting an initiative to institutionalise research into the history of medicine at the KI, and the attendant call for better documentation not least of the recent history of KI itself, is the belated process of academic professionalization of this line of research in Sweden. What follows here is a brief survey of the situation for the history of medicine in Sweden.

The situation is characterised by a fragmentation of resources and initiatives. That in not to say history of medicine is not at all being written in Sweden. There is a considerable tradition of disciplinary history writing within the Swedish medical community. The Swedish Society of Medicine (SVLS, Svenska Läkaresällskapet) has had a section devoted to the history of medicine since 1907, exercising a measure of coordination. However, the situation the SVLS coordinates is marked by a dispersion of efforts, as most work is carried out within seventeen local societies for the history of medicine, formed by medical practitioners, very often, but not always, formed around a small museum at one of the regional hospitals. These organisations also form part of the structure behind a series of bi-annual Scandinavian conferences in the history of medicine. In the best sense of the word, this constitutes traditional amateur history of medicine as practised and written by medical professionals, meaning there is a marked lack of historical professionalization.

At this point only one medical faculty in Sweden offers courses in the history of medicine, with an attendant organisation to support these, the University of Lund in the south of Sweden. To his credit associate professor Peter M. Nilsson has 20% of his work hours devoted to the history of medicine at the section for the history of medicine within the Department for Clinical Sciences. At this point it constitutes an exception though, and one of restricted scope and means.

While the institutionalisation and professionalization of historical research into the history of science is belated at the Swedish medical faculties, history of medicine is at the same time already being practised within historical and philosophical faculties at several Swedish universities. In particular the departments for the history if science and ideas, present at most major Swedish universities, have taken up history medicine as part of their domain of interests. Three senior professors of the history of science and ideas have the history of medicine as their primary research interest. Karin Johannisson author of several professionally and publicly acclaimed works on medicine and the female body, holds the professorial chair of the Swedish mother institution for history of science and ideas at Uppsala University. Ingemar Nilsson at the University of Gothenburg specialises in the history of experimental psychology and medicine in general. Roger Qvarsell has dedicated himself to the social history of medicine and public health at the University of Linköping. Qvarsell is also involved with the collaborative online Swedish medical history database, available at: http://www2.ep.liu.se/databaser/medhist/. Through their PhD-students, receiving their doctorates through the last decade or so, this group of highly accomplished historians of medicine has for the first provided Swedish academia with access to a group of professionally trained historians of medicine. For lack of independent institutional structures they are for the time being to be accommodated within the larger field of the history of science and ideas.

Medicine, and its history, has also recently garnered increasing attention from the new field of Science and Technology Studies (STS), in the form of a research interest into the advent of modern ”biomedicine” in the post WWII-era. Biomedicine under those circumstances can be regarded as a field of research into the molecular structure of life, at which point traditional dichotomies like normal-pathological become blurred. Just as importantly, the traditional distinction between medicine and biology breaks down. Consequently there at present a number of Swedish research groups within STS/history of science addressing issues like the development of the modern biotechnological industry and the history of molecular biology, which for research purposes do not, and cannot, make any clear distinction between biology and medicine.

What is lacking is the institutionalisation of the history of medicine per se as an independent historical discipline through. Traditionally it would require the establishment of a professorial chair so dedicated at any one of the Swedish universities, regardless of faculty. Any such structure would also be able to take the pick of the crop of junior historians of medicine already present, not least since Swedish academia is at present experiencing a marked dearth of junior research and teaching position on the postdoctoral level.

This situation is the premise for the suggestion that the Karolinska Institutet should as part of its 2010 bicentenary celebration take the necessary steps to create just such a professorial chair. In a sense the position of mother institution for the history of medicine in Sweden is still waiting to be filled, and it would be perfectly logical for the Karolinska Institutet to do so. It was expected that at least a preliminary decision regarding this matter would have been reached by the time of this presentation at the 2008 CASE conference. However negotiations regarding this matter are still pending.

The ambition is to reverse a negative trend for the history of medicine at the KI in the last two decades. Instruction into the subject was compulsory for students until 1907, at which point it was dropped from the curriculum, to be reintroduced as voluntary course in 1958. Research into the history of medicine was catered to first by the assistant professors Olof Hult, from 1924-1941, and Wolfram Kock, from 1953-2000. An attempt was made to provide an institutional focus for history of medicine in Stockholm through the re-establishment in 1995 of a Museum for the History of Medicine at the Karolinska Hospital, the university hospital attendant to the Institute. It was a joint initiative by the Swedish Medical Society and the KI but under the authority of the Stockholm County Council. The collection base for the museum was established by the Swedish Medical Society already in 1907, first exhibited in 1943, and between 1955 and 1991 displayed on the premises of the medical appliance company Stille-Werner. This was also the locus for the voluntary classes taught by Kock beginning in 1958. However what in 1995 was hoped to be a final solution for the museum once again eluded those involved as the museum was closed in early 2004. In conjunction with the securing of new premises for the museum, the KI also recruited a professor in medical humanities with a special responsibility for the history of medicine as part of his brief. This professorship has recently been terminated in 2007.

 The Karolinska Institutet

At this point it would seem opportune to offer the reader a quick general description of the institution our concerns and ambitions revolve around. The Karolinska Institutet is one of the leading medical universities in the world, and one of the largest in Europe. It is also the only university in Sweden to specialise in medicine, and the country’s principal centre for medical education and research. Approximately 80% of the institute’s revenues go straight into research at its 22 departments, housing 600 research groups, made up of consisting of 1400 researchers (including 310 professors) and 2100 post graduate students. About 3000 original articles and 1000 other publications were written by researchers at Karolinska Institutet 2007. In addition the institute educates approximately 6000 graduate students in 20 different educational programmes. The institute is also responsible for the largest medical library in the Nordic countries which produces the database SveMed+, and responsible for the Nordic content in Medline/PubMed. KI’s total income 2007 was 4166 million SEK (EUR 446 million, USD 648 million; exchange rate Jan-2008), out of which 48% was financed by the Swedish government.

Historically, by any metric, this institution has always been, and still is, an extraordinarily important fixture in the intellectual and scientific landscape of Sweden. While remaining a one-faculty university, its annual turnover puts it among the “great five” Swedish universities, reasonably holding its own in the middle of the top 100 universities of the world on such a list as the one compiled by the Shanghai Jiao Tong University (nr 53 in 2007, highest rated in Sweden, but recently falling behind Copenhagen for the top spot in Scandinavia).

The project - as it was proposed and how it is progressing

In 2005 as a professional historian of science Olof Ljungström was attached to the KI bicentenary project for the purposes of writing the history of scientific research at the Institute in the post-WWII era, funded by a grant from the Swedish National Bank’s Tercentenary Foundation.[2]

At this point it quickly became apparent to “Kulturenheten” at the KI, the part of the University Administration responsible for the care and maintenance of the Institutets rare book collection, art and certain historical personal archives, that some form of long term strategy and effort was necessary in order to document the recent research history at the KI, while simultaneously providing a sustainable solution to the question of long-term care and access to already existing collections of materials.

What was proposed was a plan for the establishment of a Karolinska Institutet Centre for the History of Medicine, designed to cater to both the existing older historical collection, and address the lack of documentation of current and recent history, while allowing the institutionalisation of professional academic research in the history of the science and technology of medicine. Part of the build up to such a centre was the establishment of a project specifically designed to address a lack of documentation and archiving of the recent history of research at the KI. This project was initiated in early 2007, due to a two year grant (2007-2008) again from the Swedish National Bank’s Tercentenary Foundation. Daniel Normark is currently employed in this project using these funds.

Contrary to the already indicated trend of the history of medicine occupying an increasingly precarious position within the KI, the Institute has in recent years also made a particular effort to safe-guard its the medical rare books and manuscript collections through the creation of the Hagströmer Medico-Historical Library in 1997. The book collection comprises some 20,000 printed works, most from before 1830, and the oldest printed in Venice in 1488. The historical core of the collection is the KI university library, the book collection and archive of the Stockholm “Collegium Medicum”, the association of medical professionals 1663-1812, deposited at the KI in 1816, and the medical library of the Royal Academy of Science, gifted to the KI in 1848. The manuscript archive includes the correspondence of most prominent Stockholm medical doctors of the 18th and early 19th centuries.

At present the Hagströmer Library is the single most valuable and high-profiled resource for the history of medicine at the KI. However, some of the choices made in its creation provide cause for concern. The first regards the choice of organisational solution. At this point the collection is cared for by Ove Hagelin, MDHC, through a contract between the KI and the Stockholm firm Hagelin Rare Books, of which Ove Hagelin is the proprietor. The seemingly odd choice of arrangement has for many years worked satisfactorily for both parties. There are however concerns as to the long term viability of the arrangement, as Ove Hagelin is now 68 years of age. The extreme dependency on a single individual, no matter how skilled, is a liability, and one of the aspects of the project for the creation of a Centre for the History of Medicine at the KI is precisely to provide a more sustainable long-term organisational framework for the Hagströmer Library.

As the Hagströmer Library was created by the extraction of all pre-1914 litera­ture and manuscripts from the stacks of the KI university library (Karolinska Institutets Bibliotek, KIB), certain aspects of the maintenance of historical collections were overlooked. While the KIB had hitherto maintained a manuscript collection, this part of its brief was scrapped as the Hagströmer Library took over responsibility for its care and maintenance. Up until that time personal collections of researchers and medical professionals had been possible to deposit with the library, but this function was not formally carried on over to the new organisation conceived rather as a repository for already extant historical collections. While unanticipated, the situation still needs to be addressed, which is precisely what the project geared towards the creation of an archive of the modern research history at KI is intended to do.

The plans to effectuate an increased commitment to archives and research history of medicine at the KI is to a very great extent shaped by the needs of the Hagströmer Library, as well as the anticipated necessary complementary activities we perceive as necessary. The plan calls for a triangulation of functions:

provide long-term care for, and utilise for research, the ”Hagströmer Library Medico-Historical Library collect and preserve all the devices that are used for limited period (inscription devices), while creating and maintaining historical archives for photos, personal files, institutional papers (prior to 1993) regarding KI’s research allow “in-house” research on the existing archives and education in medical history, which internally at the KI can provide much needed justification for the activities of historical documentation and collection

The means to accomplish this is a proposed Centre for the History of Medicine. As a target-vision for the project, this Centre still remains halfway through the project. We believe it to be feasible still, and have been slowly advancing towards it through the conduction of a form of “salvage anthropology”. About 200 “professores emeriti” have been contacted, and we have met approximately 60, out of which some 40 have made themselves available for extended interviews. Those that we have met jointly hold (in basements, boxes and attics) over 200 shelf meters of documents, letters etc, including a large collection of images and movies detailing a wide variety of research areas and interests of the last half-century of activity at the KI. We also located personal archives at KI from prominent researchers/clinicians such as Ulf von Euler (Nobel Prize 1970, noradrenalin), Clarence Crafoord (thoracic surgery), Viktor Olof Björk (dito) and Rolf Luft (endocrinology, mitochondrial disease, “Luft’s syndrome”), indicating that some people at KI have always had the foresight to erect unofficial archives over certain individuals deemed particularly historically significant. Other personal archives (such as that of Nanna Swartz, professor of medicine) have been deposited at Riksarkivet.

In addition to scouting for an archive, we are in the process of planning a series of witness seminars. These are being offered to various groups within the administration and departments of the Institute as a means of documenting their recent history, thereby expanding the tactics to get hold of suitable material. Proposed subjects range from the sweeping administrative reforms of the 1990’s, as the KI grew by absorbing various traditionally independent institutions for the training of medical practitioners (nurses, dentists etc.), while reorganising internally (from 140 research and teaching departments to 40), to the institutionalisation of ethics in research committees.

The situation would seem propitious for accomplishing our stated aims, with the upcoming 2010 bicentenary forming the basic premise for our efforts. Anniversaries are traditional focal points in an organisation’s history when they are expected to take stock and engage in a measure of critical reflection as to its identity and historical trajectory. Self-congratulatory as it might seem, the KI is at present such a strong centre of research, and has been so all through the post-WWII era, that the argument for a need for a fuller documentation of its activities often sells itself. The lack of a specific academic centre for the history science in Sweden has left a vacancy which in many ways it would be perfectly logical for the KI to fill. As part of the self-imagery of the KI, the example of the Johns Hopkins in the US is occasionally invoked, and it would be consistent for the KI to emulate it with regards to an initiative in the history of medicine. If so, history of medicine at the KI would form part of a triangulation of research into the history of science, technology and medicine in the Stockholm region, alongside our gracious hosts at the Centre for the History of Science at the Swedish Royal Academy, with the Dept. for the History of Technology and Science at the Royal Institute of Technology (KTH) forming the third node. Finally its role as a Nobel Prize awarder, for medicine or physiology, also contributes a considerable measure of both scientific and public interest and relevance. [3]

However, we have in the process of this work also increasingly come to realise, that all the stated “good reasons” cited do not always work to our advantage as one might have surmised. Despite the partial success of the project, we continuously encounter backlashes and negative surprises. We find ourselves charting a void as much as collecting an archive. This leads to the conclusion that there is a lack of understanding at KI regarding historical accounts and implications in general and a lack of understanding regarding the role and function of archives and achievable records in particular. In the following we outline plausible mechanisms that enable and maintain the ongoing deterioration of achievable records. Even though we present initial findings we find this “historiographic agnatology” important since the success of establishing a research centre at KI depends largely on our ability to navigate within the culture of KI.

The KI and the Swedish Legal Requirement to Keep Archives

Something needs to be said here about the fact that the Karolinska Institutet, like any other government-funded public institution in Sweden, is formally required to continuously file documentation of its activities, and how this pans out in actual fact. The KI labours under the same set of legislation as any other institution of its kind, archiving documents according to formal briefs issued by the Swedish National Archive (Riksarkivet). However, in actual practice this means two things:

First of all, the requirements as to what material must be archived long-term are quite formal. Best protected is documentation of financial transactions. From the point of view of a researcher, be it a historian or a sociologist, the material designated for relative immortality is quite narrow in scope and quantity, at least compared to the vast amounts generated. What is perhaps least catered to is research into the actual practice of scientific research. Historians are of course used to taking dearth of material in their stride, especially regarding older periods of history, but there is a mismatch between what kind of documentation the formal briefs for government institutions single out as of special importance, and the kind historians of science at present often wish to see preserved. The time requirement to keep material very often has a cut-off point (typically ten years) after which the material is discardable, and thus frequently hits “the round archive” as a matter of course. There is also a matter of a relatively low level of awareness of the formal requirements to archive things among the scientific community in general. It is a known problem and certainly not unique to the KI. The end result is still that while administrative archives of Swedish universities tend to fulfil the formal requirements, the archives of individual research departments vary considerably, are frequently very sketchy and sometimes non-existent. At the Karolinska Institutet sweeping reforms of the department structure in the early 1990’s have in fact led a form of “orphanage” for the older archives of the various research departments. The KI in 1993 reshuffled its entire research-structure in such a fashion that the entire set of records for some very high-profiled and successful research-groups at the KI were lost completely (I will return to an example of this below).

The fact that there are formal requirements to keep and maintain archives also have a more insidious effect on the “culture of preservation” in a place like the KI. It often leads to a reactive stance, and at times even an attitude of passive disobedience. I.e. since an external agent, the National Archive, exercises a supervisory function, the supervised institution does not necessarily feel under obligation to internalise the principles behind the brief to archive certain materials, at least not beyond that which is necessary for the everyday running of business. Archiving and documentation easily become regarded as a chore grudgingly accomplished, and since resources still have to be spent to provide for the formal requirements, simply “meeting the quotas” can become regarded not as a minimum requirement, but as the self-sufficient objective. The system is formal and has institutionalised the function of archives, providing a relatively high minimum standard of expectation on the quality and longevity of records, but it struggles to provide local incentive to do more. The National Archive as an external authority also lacks means of sanction, mostly consisting in the ability to “shame” a negligent party by exposure in public media. The formal requirements to maintain archives of a certain order can also function like an alibi. This can find both conscious and unconscious expression; on the one hand conscious adaptation in the sense of attempts to minimise efforts and resources to fulfil a bare minimum, but also unconscious attitudes of unrealistic expectations on what manner of service and quality the formal archives do in fact provide. In the last few years it has been our experience that many persons highly positive to our efforts at the KI have been both shocked and appalled at the state of preservation, or rather non-preservation, of documents, artifacts etc. They “knew” archives are being maintained, but hitherto never had reason to reflect on what this meant in practice. A not uncommon reaction, voice radiating incredulity, has been: “But I thought we were already keeping that?”

The Uses of History and Invention of Tradition at the KI in View of the Upcoming 2010 Bicentenary

Sociology, anthropology and cultural studies share a common interest in how acts and behaviour is made, (or accomplished) as appropriate and intelligible. Quite often they conclude that the accomplishment of “making an act” relies heavily on common-sense, taken-for-granted, cultural ‘forms of life’. Somewhat discouraging, common sense is nothing tangible, but refers to a shared belief that at best can be described by stating obvious remarks of what it is not. This is problematical for researchers in the social sciences since they are stranded without any obvious tools to observe the core subject of their profession. Hence, several approaches, methods or toolboxes have been created to amend the ambiguity of common sense. One of these methods have been labelled ‘breeching experiments’ and was introduced within ethnomethodology by Harold Garfinkel. Breeching experiments refer to the task of changing the conditions or behaviour of certain actions – thereby unveiling a crack in the cohorts’ order-productive-accomplishments. Breaching an order and showing how the cohort responds to such breaches reveals the order present in the first place.

Halfway through the project we have found ourselves conducting a breaching experiment. Our calls for attention to the state of historical documentation of the recent history of the KI elicited not so much hostile reactions, as a certain incredulity that these things were not already sufficiently provided for. The project in it self and the idea of introducing history of medicine at KI have turned out to breach the commonsensical notion of history at KI.

As we have continued our work, and understanding of the historiographic agnotology within KI becomes more and more tangible. The term agnotology was coined by Robert N. Proctor to describe culturally-induced ignorance or doubt. Its etymological origin is the Greek word agnosis which means “not knowing”. Interestingly the term captures both intentional and unintentional actions of secrecy, suppression, document destruction, cultural or political selectivity as well as neglect, inattention and forgetfulness. Proctor coined it to describe a certain consistent lack of attention to the rock agate among mineralogists through history.[4] It has since then also been picked up by his wife, also a historian of science, Londa Schiebinger, who has used it to describe the non-transfer of knowledge in the history of science, specifically how the western science of 17th c. botany consistently failed to assimilate widely disseminated knowledge of abortficiant properties of certain plants among non-European societies.[5]

Two Major Themes of “A Handbook History” of the KI

To understand the social construction of history and its subsequent agnatology at the KI, we start with the handbook history – continuously reified at websites, pamphlets presentations, conferences introductions, student courses and other initiations to the institute. This description of the Institute, and its historical prominence is two folded, first it regards the origin of the institute and second its role as awarder of the Nobel Prize in physiology and medicine. Or as it is reproduced within the KI:

It all began with army surgeons…

Karolinska Institutet was founded in 1810 to provide urgently needed training for the army surgeons working among wounded soldiers in the field. Today, Karolinska Institutet is a modern medical university and one of the largest in Europe.

One of those who helped to establish Karolinska Institutet was the eminent Swedish scientist Jöns Jacob Berzelius, whose outstanding research in chemistry laid the foundations for the university’s scientific orientation.

Over the years, five research scientists from Karolinska Institutet have been awarded the Nobel Prize for Physiology or Medicine.[6]

A Myth of Origin

“lärowerk för skickelige Fältläkarares tilldanande”

(a school for the formation of accomplished field-surgeons)

Sweden suffered a devastating defeat in the war against Russia in 1808-09. The war was also the first in which the Swedish army relied exclusively on a national corps of army surgeons (instead of going on a massive hiring spree among German and Dutch surgeons as part of the preparations for war). The subsequent defeat in that war was in part blamed on the poor quality of army medical corps and this has, since then, been described as the motive for instituting the Karolinska Institutet. Shortly after the KI was founded, in 1822, it became an obligatory passage point for all the doctors in Sweden since they all had to get their surgical training at the institute. It is perhaps important to remind the reader that Stockholm at that time was the only city in Sweden that could provide enough bodies and patients to conduct surgical training. Hence KI quickly became important for the medical profession in Sweden, which of course was contested. A struggle of the authority, autonomy, mission and status of the Institute took place in different phrases between 1829 and 1906.

This struggle is often portrayed as David’s battle against Goliath, where KI, the plucky underdog, successfully survived the onslaught by the universities. The conflict is regularly personalised as a contest between the world renowned chemist Jacob Berzelius and the head of the medical faculty at Uppsala university, Israel Hwasser. While Berzelius is presented as a empiricist rationalist, a “real scientist”, and implicitly assumed to be right through his ability to apply scientific reason “correctly”, and with whom a modern audience is invited to identify, Hwasser is presented as an archetypical confused 19th century idealist romantic, all verbiage and no intellectual rigour. While it is true that Hwasser stylistically is obscure and very far removed from modern sentiments, he was still an effective clinician at an age when medicine knew precious few truly remedial substances. One can also keep in mind that Berzelius himself must be regarded as an “empiricist vitalist”, loathe to accept the findings of his friend and colleague Friedrich Wöhler who in 1828 managed to in vitro produce urea from inorganic compounds contrary to all vitalist claims of a special “life force” necessary for organic chemical processes.[7]

But in fact the situation was never as skewered against the KI as claims would have it. What is true is that the KI found itself occasionally in focus of a political battle between conservatism and nascent liberalism during the first half of the 19th century, and that the forces in favour of a continued status quo did side with the universities, home of traditions stretching back to the Middle Age. It is obvious that the long-standing denial of certain rights of examination hampered the KI through the 19th c., but it is equally true that while there were serious proposals to dismantle the traditional universities of Uppsala and Lund and transfer them to the capital, no equally serious call for the abolition of the KI were ever made. It is hard to see how the association with political liberalism on the ascendant really hampered the development of the KI.

The Nobel Prize awarder

The second image of KI, as a successful modern biomedical research institute, hinges heavily on the institutes role as awarder of physiology and medicine. As a pamphlet on the history of the Karolinska Institutet points out:

The importance of the task of Nobel Prize-awarder for the luminosity of the Karolinska Institutet brand-name can hardly be overestimated. No other medical university is annually thrust into view of the scientific community, and the world, as the Karolinska Institutet, when the laureates for the Nobel Prize for medicine or physiology are announced.[8]

The importance of the Nobel Prize for the Karolinska Institutet cannot be disregarded, for good and for worse. It is a fundamental aspect of the Institute’s perception of itself. Through the Nobel Prize an act is conducted by the Karolinska Institutet which is in itself of historical value, regardless of any research contribution made by the Institute itself. In addition the Prize has allowed the externalisation of the function of an historic memory with little ill-effect; a sufficient number of high-profiled actors already maintain that function (the Nobel Institute, the Nobel Museum, the Swedish Royal Academy of Science, universities and institutes with one or more Nobel laureates, etc) As such the Nobel Prize provides the KI with a sufficient history “for free”, so to speak, to provide members of the Institute with a sense of identity intimately tied to the Nobel Prize. The annual Nobel Prize for physiology or medicine at this point would seem to provide the KI a sufficient guarantee that it will not have to suffer the ignoble fate of scientific historical irrelevance, regardless of any action of its own to safeguard such a history. In conclusion one can argue that the Nobel Prize for medicine or physiology in many ways acts as a “historiographic alibi” for the KI.

Cultural Attitudes Towards History at the KI

By looking at the “handbook history” of the KI in addition to our work of charting the voids of historically valuable research material enables us to outline the mechanisms underlying the “historiographic culture at the KI”. There is in many ways a misconception of what history is – or has lately turned out to be - at the KI. The dominating attitude is rather one of what might be called “historical naivety”.

- First, a highly traditional positivist, progressive, view of the history of science still persist at the institute and this view of history is seldom questioned or the critique is simply ignored.

- Second, analogous to a view of “science as ready made” history is also perceived as “ready made” – it should be sufficient for the historian to look at the bibliographic record of the researcher to unveil the historic contribution of that individual. As Latour points out in his early work, “science ready made” coexists with its counterpart “science in the making” and for critical historians it is important to unveil the traces, associations and actors in both faces of science.[9] History, or humanistic and social science at large are much more “sciences in the making” rather than “ready made”.

- Third, in this culture it is expected by representatives of disciplines (or spokespersons) to regularly provide autobiographical history that captures the contribution of that discipline. At the KI, especially two books have provided this aspect one published in 1910 and the second book was published in 1960. Several of the professor emeriti’s that we have interviewed have asked for the upcoming book expected 2010 – that would be a continuation of this tradition.

As a general rule of thumb (with some interesting exceptions), historic accounts of the KI as written by senior researchers themselves still tend fall within traditional moulds of disciplinary history. The development of scientific knowledge is regarded as a continuous, progressive and cumulative endeavour, as summed up in the OTSOG-formula: i.e. Sir Isaac Newton’s observation that if he had seen further than other men, then ostensibly this was because he had been standing On The Shoulders Of Giants. It is a very old genre of biographical history writing focusing on exceptional individuals and harking back to one of the original and primary functions of the writing of history present at least since the ancient Greek, that of providing historical “exempla” in the form of biographical accounts intended either as accounts of “exemplary lives” (or occasionally inversely as cautionary tales), with the audience actively invited to identify with the protagonists.

We argue that these mechanisms allow a “historiographic agnotolgy”. First, a continued lack of professionalization of the functions of documentation of sources and historical analysis. Due to this agnotology, there is a lack of understanding at the KI regarding historical accounts and implications in general and a lack of understanding regarding the role and function of archives and achievable records in particular. Second, this agnotology enables a continued reification of an under-problematised handbook history of the institution and of science. Teachers and students alike can refer to great men of science to explain their role in history without any critique or reflection of those associations.[10]

Historical Practice at the KI, Some Examples

It might not be fair for us as historians to argue that a medical university, whose main purpose is to make medical science, should be better skilled in preserving its historical legacy and more knowledgeable about history. However the agnotology at the KI creates irreversible consequences for historical research on the Karolinska Institutet. The cultural ignorance destroys – literarily – the second wave of historical research. The traces, paper trails and machines tend to be already gone by the time historians start their investigations.

For example: A prominent researcher, world leading in his field (who shall here remain nameless), still works at the institute, and has conscientiously over the years collected all his documents, from notebooks to conference protocols. As these were important documents, they were expected to eventually be transferred to the central administrative archive of the Institute. As the known proprietor of such a considerable personal archive, colleagues turned to this man, who retired in 1999, with requests for information. He still had at his disposal an office University Hospital, where most of his archive was stored in the basement – or so he thought. When, prompted by the questions of others, he recently went down to investigate, all he found was empty shelves and no explanation as to where everything has gone has been provided. Neither the fame of the researcher, or the fact that he was still working at the hospital, had saved this material form being discarded at some unspecified time, for some as yet unspecified reason.

Another example can be found by looking at one of the Karolinska Institutet’s most prominent researchers, the professor of biochemistry Hugo Theorell (1903-1982), for many years the head of his own research department at the Nobel Institute for Medicine at the KI, jointly funded by the Rockefeller Foundation, the Swedish industrialist Wallenberg family and the Swedish government. He became the KI’s first Nobel Laureate in 1955, for his discoveries concerning the nature and mode of action of oxidation enzymes. For such a prominent actor at the Karolinska Institutet one would expect shelf-meters of documentation for historians to immerse themselves in. The reality however is much more discouraging. The only thing preserved from his, and his group of researchers, activities at the Nobel Institute, is the note-book listing the inventory of instruments and machinery bought and used by the biochemistry section at the Nobel Institute in the period 1938-1982. Even then, the archivists at the KI have informed us that there is no formal obligation for the Institute to preserve this document either, as it falls outside the range of things it is under obligation to preserve. Everything else has already been discarded. From the perspective of the Institute the entire working life in science of Hugo Theorell has been reduced to a commemorative medallion awarded to him in 1955.

But as luck would have it, individual acts of preservation have saved some material for the historians. One of the medical engineers employed by Hugo Theorell, later himself receiving a professorial position at Stockholm University, saved several of the instruments used from destruction. At least one piece of machinery received a new lease on life at Stockholm University, before it was replaced, and the “inscription device” was moved to a space underneath the culverts of the basement.[11] The correspondence regarding said machine (a 500 kg magnet) has been preserved, but more by to accident than conscious retrieval. The papers were kept in the cabinet of another engineer and spared destruction out for a fit of forgetfulness. A lab-notebook kept in 1934 and belonging to Hugo Theorell was also saved by the same engineer. Finally family and friends of Hugo Theorell have salvaged bits and pieces of his work – but the material in some ways at present bears a greater resemblance to the material of an archaeologist than to that of a contemporary historian.

Our third example refers to the surgeon Clarence Crafoord, and deals less with the direct problem of lack of sources, but rather with mechanisms involved in the writing of history of science and medicine which highlight the need to make sources accessible for research.

Clarence Crafoord (1899-1984) was a pioneer in thoracic surgery, with an active career between 1922 to the mid 1960’s. The the pioneering aspects of his work certainly calls for an historical examination of how, and with whom he worked. Luckily his well kept personal archive has been preserved, and is kept at the Karolinska Institutet in the state it was left at his demise. (This comparatively positive state of affairs is largely due to the conscientiousness of his secretary, who worked for Crafoord until his death in 1984, and to his children). At this point there is no funding to survey or further arrange the material, much less make it searchable. Thus the archive drops “below the radar” for most researchers interested in the pioneering years of thoracic surgery. While perfectly known in principle that the race to build a functioning assisted breathing apparatus, or make direct surgical intervention on the heart etc. was in fact a highly international affair, in practice the actual history being written has a tendency to become a national affair, primarily dominated by accounts of the American surgeons. Looking in PubMed gives a rough confirmation of our original intuition. “Crafoord C” gives 10 hits, 3 published before 1960, 3 minor texts in Swedish, and 4 articles that are biographical. Looking at “Gross RE”, i.e. his main competitor Robert Edwards Gross, elicits 12 hits, all published after 1980 and biographical.[12]

Taking up Crafoord at the KI, as we approached different very senior researchers in surgery, they would confront us with the counter-question where the great scientific biography of Clarence Crafoord is?[13] Their sense of urgency is due to a perception of the memory of Clarence Crafoord inexorably edging towards oblivion. But this is not due to the lack of an archive, but because this archive is neither known nor available to most researchers in the history of medicine.

When comparing the short list of publications dedicated to Gross with the one dealing with Crafoord, what is striking is the temporal distribution of these, as well as the authors and their motives. Upon their demise Gross and Crafoord fared equally well as giants of thoracic surgery, garnering a roughly equal amount of eulogies (and we assume equally defferential). For a couple of decades to follow, the historical reputation of both men were sustained by articles published by members of their networks of first colleagues, later disciples, growing increasingly senior as the years progressed. At this point in time, the number of senior surgeons with direct personal experience and ties to either of the two, is inexorably dwindling as time marches on. What is about to happen is that Gross, reasonably available through archives in the US, is becoming subject to attention from professional historians of science and medicine, while Crafoord is not. Consciousness of his life and achievement is dwindling, amnesia is spreading…

The moral of the story is, that the mechanisms of the writing of history are often poorly understood, not least by professional medical researchers. The disciples of Crafoord, who have maintained his reputation, have reached an age where their own demise is looming. This is what upon contact with us as historians prompted them to request a salvaging of Crafoord on our part. It is understandable, but since historians tend to (if only implicitly) calculated the “alternative cost” of any research to be undertaken, if sources are unavailable, or simply difficult and time-consuming to access and work with, odds are potential projects will get passed over in favour of something with a better prospect of quick returns. And what applies for the troubled situation regarding Crafoord’s continued historical relevance, also applies for the entirety of the history of the Karolinska Institutet. Relative negligence of the need to maintain quality archives, allowing critical research, makes the KI run the risk of historical marginalisation by comparison to similar institutions. The project “Archive for the History of Medicine” (2007-2008), already in operation as a pilot study for the possible future greater project, is as much an endeavour of education, labouring against the current of the KI’s “historiographic agnatology”, as it is a project of acquiring personal archives on modern history of medicine.

What we discern here, is an outline of how the “future proofs” of scientific activity at the Karolinska Institutet, and its relative historical importance, will eventually simply disappear, for lack of attention and understanding of the mechanisms of history-writing and the crucial role of quality documentation at the KI.

 

[1] Stanley J. Tambiah, Magic, Science, Religion and the Scope of Rationality (Cambridge, 1990), p. 28.

[2] This project remains in effect separate from the projects directly presented here.

[3] As Robert Marc Friedman pointed out in his key-note lecture, an important aspect in order to understand the appointments of the Nobel Prize is to investigate the appointers, and their research context. This requires the searchlights to be turned onto the academic community at the KI.

[4] Nancy Marie Brown, “The Agateer”, Research – Penn State, 2001, vol. 22, issue 3, http://www.rps.psu.edu/0109/agateer.html

[5] Londa Schiebinger, ”Feminist History of Colonial Science”, Hypati,, 2004, vol. 19, issue 1, also Schiebinger, Plants and Empire: Colonial Bioprospecting in the Atlantic World (Cambridge MA, 2004).

[6] An introduction to the Institute, reproduced regularly cf. Anual report 2004, 2005, 2006

[7] Sunetra Gupta, “A Victim of Truth: Vitalism Was an Attempt to Reconcile Rationality with a Sense of Wonder”, Nature 407, 677 (12 October 2000).

[8] Vår gemensamma historia, Karolinska & Karolinska Institutet (Stockholm, 2006) p. 22:

[9] Cf Bruno Latour, Science in Action: How to Follow Scientists and Engineers Through Society (Cambridge MA, 1987), where science ready made vs science in the making is coined, and also Latour, The Pasteurization of France (Cambridge MA, 1988).

[10] However calls for a more reflexive and critical take on history do occur. There are for instance the two generations of leading 19th c. anatomists at the KI. Anders Retzius (1796-1860) and his son Gustaf Retzius (1843-1919), have in recent years increasingly become the subjects to a criticism external to the KI, due to the nature of their research in comparative anatomy branching off into physical anthropology and studies of race. Anders Retzius in particular has gone down in the history as the inventor of the so-called “cephalic index”, and assembled a large collection of exotic human crania at the KI, later expanded upon by his son Gustaf, a noted neurologist.

[11] It has through our efforts recently been repatriated to the KI, where the modern department which is technically the progeny of the old biochemistry unit is planning to turn in into an exhibition piece.

[12] Search in PubMed on subject: “Crafoord C” and “Gross RE” (2008-05-29) contact authors for details.

[13] There is in a substantial biography written by one of Crafoord’s disciples in a hagiographical style, published in French in the mid 1980‘s, Roger Benichoux’s Quand les chirurgiens était rois: La vie de Clarence




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