Virchows Archiv (2022) 480:1231–1238 https://doi.org/10.1007/s00428-022-03284-w ORIGINAL ARTICLE Voices from the past: results of the ESP history of pathology working group survey on pathology museums Raffaella Santi1 · Roberta Ballestriero2,3 · Vincenzo Canzonieri4,5 · Jacek Gulcznsky6 · Rosa Henriques de Gouveia7,8 · Aurelio Ariza9 · Lina Carvalho8 · Gabriella Nesi10 Received: 1 December 2021 / Revised: 12 January 2022 / Accepted: 18 January 2022 / Published online: 26 January 2022 © The Author(s) 2022 Abstract While keeping their original purpose of training medical students, pathology museums hold great biological value, offering unique specimens for scientific research through modern radiological, pathological and biomolecular techniques. Moreover, the artefacts, models and drawings displayed in these museums are a precious cultural and artistic heritage. Preservation of the anatomical samples and maintenance of the facilities are neither easy nor inexpensive and call for patronage. The development of a European Pathology Museum Network would undoubtedly facilitate study, access and divulgation of antique pathol‑ ogy collections. Data from a survey conducted by the European Society of Pathology (ESP) History of Pathology Working Group have allowed creation of a comprehensive, multifaceted portrait of European university museums, reflecting their history, diversity, geography, institutional status, stakeholders, projects, professionals, audiences, policies and best practices. Keywords Pathology museums · Anatomical collections · Biological archives · Medical education Introduction acknowledges can inspire new generations of undergraduate and postgraduate students. Since its foundation in 2010, on the initiative of Professor Anatomy and pathology museums are no exception to Jan G. van den Tweel (1942–2020), the European Society of the gradual loss of interest in scientific museology, and, Pathology (ESP) History of Pathology Working Group has without forgetting their conservative priorities, it is manda‑ grown steadily, thanks to the commitment of all its mem‑ tory to keep in step with the times if they are to maintain bers of different ages and from different scientific fields. The their original didactic role [1]. During the first half of the main goal of the Working Group is to spread the values of twentieth century, pathology museums were a principal historical discoveries, messages and material, which the ESP educational resource in medical schools. Since the dawn of modern medicine in the second half of the twentieth 7 * Gabriella Nesi Histology and Pathology, Faculty of Life Sciences, gabriella.nesi@unifi.it University of Madeira (UMa) & Clinical and Anatomical Pathology Laboratory (LANA), Funchal, Madeira, Portugal 1 Hematopathology Unit, Careggi University Hospital, 8 Anatomical and Molecular Pathology Institute (IAP‑PM), Florence, Italy Faculdade de Medicina da Universidade de Coimbra 2 Academy of Fine Arts of Venice, Venice, Italy (FMUC), Coimbra, Portugal 3 9 Art Historian in Residence, Gordon Museum of Pathology, Department of Anatomic Pathology, Hospital Germans Trias King’s College, London, UK I Pujol, Autonomous University of Barcelona, Barcelona, 4 Spain Pathology Unit, Centro di Riferimento Oncologico di Aviano 10 (CRO Aviano), IRCCS, National Cancer Institute, Aviano, Division of Pathological Anatomy, Pathology Section, Italy Department of Health Sciences, University of Florence, V.le 5 G. Pieraccini 6, 50139 Florence, Italy Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy 6 Department of Pathology and Neuropathology, Medical University of Gdansk, Gdansk, Poland 13 Vol.:(0123456789) 1232 Virchows Archiv (2022) 480:1231–1238 century, an ever-increasing body of knowledge has been study, access and divulgation of historical collections. The progressively included in the medical curriculum and the ESP History of Pathology Working Group has endeavoured teaching of gross pathology disparaged. Museums that have to produce a comprehensive picture of the many facets (i.e. survived this cultural upheaval can be found all over the history, diversity, location, institutional status, existing world, mainly in Europe. Several university-related collec‑ networks and stakeholders, projects, professionals, audi‑ tions are also located in North America, South America and ences, policies, best practices and publications) of European Australia, such as the Maude Abbott Medical Museum in pathology museums. Montreal, the Johns Hopkins Medical Institutions (including the Department of Art as Applied to Medicine) in Baltimore, the Oswaldo Cruz Institute in Rio de Janeiro and the Harry General features of the survey Brookes Allen Museum of Anatomy and Pathology in Mel‑ bourne [2]. Many of these early “pathology classrooms” are Twenty-seven members of the ESP History of Pathology still in use, reshaping and reinventing themselves to stay rel‑ Working Group, from 14 countries, participated in the study evant in a digital world. The same technical ways and means (Fig. 2). The online survey was available on the ESP website of communication that now rival traditional museums can 2 years from May 2017. It comprised 24 closed- and open- contribute to their innovation and improve access to ancient ended questions (Table 1) concerning four main issues: (i) collections, through digital photographs and documenta‑ museum organisation and structure, (ii) type and number tion recorded on appropriate appliances (CD-ROM, DVD) of objects, (iii) collection experiencing and sharing and or shared via the World Wide Web [3]. For any anatomical (iv) strategies and challenges for contemporary pathology specimen in the museum, a “route” may be contemplated museums. covering patient clinical details, radiological images and histological findings, along with up-to-date literature on the topic. Scientific interpretation and contextualisation of the Museum organisation and structure historical case will offer students a novel educational experi‑ ence and scholars a chance for deeper investigation. To all The vast majority of respondents are affiliated to academic intents and purposes, anatomical collections are “biological institutions with the exception of one independent collection archives” open to research through state-of-the art imaging centre. Approximately 30% of pathology museums do not and biomolecular technologies (Fig. 1). have dedicated employees. If they do, staff consists of one Preservation of specimens and facilities is neither easy or two persons in 50% of cases and three or more in 23%. nor costless and calls for patronage. The development of a For hundreds of years, educational and training pro‑ European Pathology Museum Network would promote the grammes developed in pathology museums have been Fig. 1  Representative scheme of the diagnostic approach to antique specimens/artefacts housed in pathology museums. In the foreground, over‑ view of the Pathology Museum of the University of Florence, Florence, Italy (photograph by Lorenzo Mennonna) 13 Virchows Archiv (2022) 480:1231–1238 1233 Fig. 2  Map of the countries participating in the survey. Each pointer represents one or more participants milestones along the path to becoming a physician. It was students in medicine, and museums have become remote during the sixteenth and seventeenth centuries that specific islands of mainly historical interest [8]. Conversely, the spaces, housing anatomical and pathological specimens importance of pathology museums should be explained to were instituted with the aim of teaching medical students medical students during pathology lectures and visits be [4]. Pathological collections substantially improved when encouraged. Indeed, with the decline of autopsy rates, direct the fixation techniques, devised by Johann Carl Kaiserling observation of basic tissue processes (e.g. peptic ulcer dis‑ (1869–1942) and Leonhard Jores (1866–1935), allowed the ease, myocardial infarction) using gross specimens and/or natural colours of moist preparations to be maintained or artefacts held in the museum would constitute an incompa‑ restored for long-term display [5]. rable learning experience. Comprehension of the dynamic “He who attempts to teach anatomy without a museum”, course of diseases would also benefit from a morphology- stated the Scottish anatomist Frederick Knox (1794–1873), based approach. Pathology museums, moreover, are key “strictly deserves the name of impostor” [3]. Museums con‑ places to explore major developments in scientific thought tributed to promoting morbid anatomy as a distinctive spe‑ and the impact of science on human culture and behaviours. cialty. By the middle of the eighteenth century, all eminent medical teaching institutions had a museum, and the curators evolved from “inspectors of the dead” to lecturers in mor‑ Type and number of objects bid anatomy, or in some instances reached the more privi‑ leged title of “Professors of Pathology” [6]. The relationship Museum collections encompass wet/dry specimens and arti‑ between medical museums and pathology as a discipline is ficial models in various proportions, with the former being also highlighted in the seal of the International Academy more frequent (Fig. 3). The majority of specimens (59%) are of Pathology (IAP). The lettering “IAMM 1906”, inscribed described using original clinical documentation. Approxi‑ below the microscope, globe and lamp of wisdom, stands for mately half of the institutions (52%) record up to 1000 the International Association of Medical Museums, founded objects, 38% from 1001 to 5000, and 10% as many as 10,000 by Maude Abbott from McGill University in 1906, which or more. Various aspects of pathology are represented, rang‑ eventually gave rise to the IAP in 1955. ing from congenital to neoplastic diseases; however some With the use of the microscope for scientific purposes in collections specialise in one or a limited number of medical the first decades of the nineteenth century, histopathology branches, e.g. dentistry, dermatology and cardiology. emerged as a new medical field and became the prerogative Anatomical and pathological specimens are usually pre‑ of pathologists [7]. Pathology was taught to medical stu‑ served in formalin-based solution in fully labelled glass jars. dents, who gained knowledge of gross pathology through the Before adequate fixation techniques were available, the dif‑ examination of museum specimens and of histopathology ficulties in conserving pathological material prompted the through the study of tissues under the microscope. Now‑ decision to set up duplicates in order to instruct young doc‑ adays, hands-on practice of gross pathology and histopa‑ tors without resorting to corpse dissection. Among the vari‑ thology is seldom part of the curriculum for undergraduate ous materials by which models are made, wax takes pride 13 1234 Virchows Archiv (2022) 480:1231–1238 Table 1  Questionnaire used to conduct the ESP survey on pathology museums/collections (light grey boxes indicate open-ended questions) Q1 Name of museum Q2 If the collections are not your responsibility, please advise us who to contact, or forward the email invitation or questionnaire to the appropri‑ ate person Q3 Contact person: Q4 Address of museum/collection: Q5 Are you willing to be contacted to provide further information about this survey? - Yes - No Q6 Type of Museum (determined by its most important funding source): - Independent - University - Other (please specify) Q7 How many collection staff (curators, conservators, collection managers, store people, etc.) are employed? Q8 Will this information be about the whole museum/collection? - Yes - No - If so, please specify Q9 How many objects are there in the collections? Exclude inaccessible collections such as archives or bulk finds - 1–500 - 501–1000 - 1001–5000 - 5001–10,000 - More (please specify) Q10 Genre of objects: - Wet specimens - Dry specimens - Artificial models in wax, clay, glass, plastic, etc. (please specify) Q11 Are the collection specimens documented by original clinical records? - Yes - No Q12 What are the most important topics/issues your museum addresses? Q13 Is there a member of staff or an independent scholar conducting research on the collections? - Yes - No - If so, please specify Q14 Can the public access the stored collections? - Yes - No Q15 If so, please tick all that apply: - Visible storage as part of normal displays - Advertised visits for public or for groups - Pre-booked visits for groups - By appointment -visitors can work with objects in store - By appointment -objects are brought to visitors - In a specially designed workplace for visitors Q16 Do you record the number of visitors accessing your collections each year? - Yes - No of place. Wax models portraying normal and pathological anatomy are often hidden gems in scientific museums. The 13 Virchows Archiv (2022) 480:1231–1238 1235 Table 1  (continued) Q17 How do people access details of the contents of the collection? Please tick the three most widely used routes. If there are more than three, please add to “other” - Online catalogue - Internally published hard copy catalogue - Externally published catalogue - Telephone enquiry - E-mail enquiry - Written enquiry - Word of mouth Q18 Are the collections listed online? - Yes - No Q19 Do you have plans to implement collection information online? - Yes - No Q20 Are there any plans to increase use of collections? - Yes - No Q21 If so, please tick relevant options below: - Open storage - Collections centre - Regular tours - More displays Q22 Which of the following are the main obstacles that hinder use of the stored collections? Please tick the three most important. If there are more than three, please add to “other”: - Limited staff - Limited resources - Physical constraints of space - Lack of money - Poor collections documentation - Security issues - Preservation/conservation issues - Lack of public interest - Low strategy priority - Other (give details) Q23 Would you like to comment on any part of the questionnaire? - Yes - If so, please specify - No Q24 Is there anything else you think we should take into account? - Yes - If so, please specify - No development of pathology as a scientific discipline was an All the same, one should not underestimate the artistic value important prerequisite to the art of moulaging [9, 10]. Dur‑ of these works. ing the nineteenth century, wax models gave medical stu‑ Clinical histories and autopsy records are invaluable dents practical knowledge of both normal and aberrant pro‑ resources for scientific investigation into museum collec‑ cesses, not always possible with fixed organs and tissues. In tions. Contextualisation of the medical knowledge of the addition to tridimensionality, moulages offered the “dimen‑ time, enriched with fragments from the personal stories of sion” of colour, a key element for correct gross diagnosis. patients, unveils the cultural value of these specimens. A 13 1236 Virchows Archiv (2022) 480:1231–1238 Fig. 3  A The Gordon Museum of Pathology, King’s College London, ing to survey results (bar graph). D Guttate psoriasis, wax moulage United Kingdom. B Bar graph of survey results to the question: “How by unknown wax artist, nineteenth century, Pathology Museum of the many objects are there in the collections? Exclude inaccessible col‑ University of Florence (photograph by Lorenzo Mennonna) lections such as archives or bulk finds”. C Genre of objects accord‑ detailed catalogue helps achieve the educational purpose of Multimedia and information technology has dominated a collection, providing evidence of which organ systems and medical education over recent years. Virtual microscopy diseases are on display [11]. Without a catalogue, a museum courses and technically elaborated learning tools are in easy loses its voice and therefore the possibility to recount the reach of pathologists and their students. Digitisation presents story behind an object. a great opportunity for scientific museums, providing access to materials via the web, minimizing damage to original items, increasing interest in these institutions and ensuring Collection experiencing and sharing maximum public access to their collections [5, 12]. Indeed, one of the tasks of a pathology museum is to convey human Public access is allowed in 48% of pathology museums. In pathology to the general public. It is one thing to say that approximately one third of these cases, stored collections “smoking can seriously harm your health”, but quite another are part of normal displays, with the remainder preferring to to show the real lung of a smoker and the consequential design museum experience as pre-booked visits (47%) and damage caused to its structure. advertised events (13%), or having a specific workspace for the purpose (7%). The majority of institutions (54%) do not register the number of visitors. “Word of mouth” (53%) is Strategies and challenges for contemporary the main means of communication regarding contents of the pathology museums collections, while written/e-mail/telephone enquiries are the rule in 30%. A few museums rely on Internet resources (4%), Approximately 60% of institutions plan to implement and 13% hold a hard copy catalogue. Collections are listed collection information online, and a higher proportion online only in 12% of cases. of responders (86%) aim to increase use of collections. 13 Virchows Archiv (2022) 480:1231–1238 1237 In particular, strategies to improve the use of collections among cultures in a perspective of mutual understanding include establishing a collection centre (38%), allowing and enrichment. open storage (29%), scheduling regular tours (15%) and organising more displays (18%). Unfortunately, the general feeling is that innovation is hampered by limited financial Conclusions resources (25%), staff shortages (25%) and lack of space (18%). Pathology museums hold materials unique in displaying Due to difficulty in sourcing new samples to museum anatomy and disease in three dimensions. They generally exhibits, there has been no increase in many collections, encompass different types of collections, each integral to the whose integrity is threatened by the inherent fragility of other in outlining a cognitive path. This body of evidence, anatomical preparations [13, 14]. Curators are therefore re-interpreted on the basis of current medical practice and committed to preserving antique specimens while ensuring implemented by radiological, histological and biomolecular their availability for current research projects. Recently, the data, allows a more accurate diagnostic definition of antique role of imaging techniques, such as nuclear magnetic reso‑ anatomical preparations and the assessment of new museo‑ nance (NMR) and computed tomography (CT), has been logical strategies. highlighted in the study of osteological preparations and Promotion of these institutions relies on standardised specimens in fixative liquid, which no longer need to be approaches of conservation and cataloguing, but introduc‑ removed from their original glass jars [15–17]. A digital tion of multimedia and interactive systems is equally essen‑ library of radiological images could offer an efficient answer tial. Permanent digital archives of anatomical collections to conservation problems. It could also serve as a useful tool should be created, thereby facilitating research and coop‑ in diagnostic definition of museum specimens and, more eration networking. Cultural heritage is the legacy that we generally, in teaching anatomo-radiological correlations attain from the past, experience in the present, and convey [17]. Furthermore, the application of modern immunohis‑ to future generations. tochemical and molecular techniques to historical long-term preserved fixed tissues has proven feasible, opening new Acknowledgements The authors remember with affection and grati‑ lines of research [18, 19]. tude Professor Jan G. van den Tweel, who passionately contributed to the advancement and success of the ESP History of Pathology Work‑ Antique anatomical collections allow the study of disease ing Group. aetiology and pathomorphosis in relation to the profound changes in socio-economic conditions of resident popula‑ Author contributions Raffaella Santi, Roberta Ballestriero and Gabri‑ tions over the centuries. Most preparations date back to the ella Nesi conceived and designed the study. Material preparation, data pre-industrial or pre-antibiotic era, and it is now common collection and analysis were performed by Raffaella Santi and Gabriella Nesi. The first draft of the manuscript was written by Raffaella Santi knowledge that genome-environment interactions play a and all authors commented on previous versions of the manuscript. All crucial role in human carcinogenesis. Molecular investiga‑ authors read and approved the final manuscript. tions on ancient tumours can help shed light on the history of cancer and the relationships between genetic alterations, Declarations lifestyle and environmental risk factors [20]. Pathology museums may also contribute to the study of occupational Conflict of interests The authors declare no competing interests. diseases that paralleled the Industrial Age, illustrating the effects of toxic substances such as lead and arsenic. These Open Access This article is licensed under a Creative Commons Attri‑ bution 4.0 International License, which permits use, sharing, adapta‑ collections are therefore valuable not only for their original tion, distribution and reproduction in any medium or format, as long educational purposes but also for their documentation of dis‑ as you give appropriate credit to the original author(s) and the source, eases already eradicated or rendered infrequent by improved provide a link to the Creative Commons licence, and indicate if changes diagnosis and treatment. were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated Management, custody and display of human remains otherwise in a credit line to the material. If material is not included in entail a vast amount of responsibility regarding several eth‑ the article's Creative Commons licence and your intended use is not ical and legal issues. Historical museum exhibitions may permitted by statutory regulation or exceeds the permitted use, you will reflect the attitude of Western Countries prior to the recogni‑ need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. tion of human rights and respect for other cultures [21]. Far from bona fide research purposes, putting race as a defining category for human specimens had supported pseudosci‑ entific theories of discrimination. Museum curators should offer appropriate tools to view collections in their histori‑ cal and cultural context, endorsing inclusion and dialogue 13 1238 Virchows Archiv (2022) 480:1231–1238 References 13. Byard RW (2007) The use of archival tissues, organs and pathol‑ ogy museums: “mortui vivos docent” (let the dead teach the liv‑ ing). Forensic Sci Med Pathol 3:175–176. https://d​ oi.o​ rg/1​ 0.1​ 007/​ 1. 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