Advances in medical science and medical practice throughout the twentieth century, and especially after the Second World War, have proceeded at such a pace, and with such an intensity, that they provide new and genuine challenges to historians. Scientists and clinicians themselves frequently bemoan the rate at which published material proliferates in their disciplines, and the near impossibility of ‘keeping up with the literature’. Pity, then, the poor historian, trying to make sense of this mass of published data, scouring archives for unpublished accounts and illuminating details, and attempting throughout to comprehend, contextualize, reconstruct and convey to others the stories of the recent past and their significance. The extensive published record of modern medicine and medical science raises particular problems for historians: it is often presented in a piecemeal but formal fashion, sometimes seemingly designed to conceal rather than reveal the processes by which scientific medicine is conducted. As Sir Peter Medawar suggested, in his famous article, ‘Is the scientific paper a fraud’, much scientific literature 'misrepresents the processes of thought that accompanied or gave rise to the work that is described...’, not deliberately intended to deceive, but structured and arranged in a rigid format that allows for little individual expression or amplification. Recourse to unpublished archives for elucidation can introduce additional difficulties. Official archives may have limitations on access: some public records and most clinical records may be subject to restrictions that keeps papers hidden for many years. Equally, specialist archives can present problems: the survival of personal papers can be erratic, many are lost during the lifetime of an individual, as space constraints or relocation demand the jettisoning of material without proper regard for its significance. Probably even more papers are wrongly discarded as worthless and uninteresting by their owners, or by relatives acting immediately after a bereavement.
Thus historians of contemporary medicine and science are increasingly turning, or returning, to the traditional technique of oral history to supplement, or extend, existing records, and to create new resources. Recognizing that many of the principal sources of contemporary medical history are still with us, they are attempting to hear, and record, their accounts. A particularly specialized form of oral history is the Witness Seminar, where several people associated with a particular set of circumstances or events are invited to meet together to discuss, debate, and even disagree about their reminiscences. Originally developed by the Institute of Contemporary British History (ICBH), this format attracted the attention of the History of Twentieth Century Medicine Group, which was inaugurated by the Wellcome Trust in 1990 (and moved to UCL 2000–10, now at Queen Mary, University of London, as the History of Modern Biomedicine Research Group), to bring together clinicians, scientists, historians and others interested in contemporary medical history. An initial experiment was to organize a meeting with the ICBH on the subject of ‘Monoclonal Antibodies’, which was held in September 1993. The response from those taking part or attending that meeting, and subsequent requests for the transcript, convinced the group’s Programme Committee that this forum should be developed. During the following summer a meeting on ‘Renal Transplantation’ was organized, and in the academic year 1994–95 a number of smaller ‘mini’ Witness Seminars were included as part of the routine programme of the group.
Since then Witness Seminars have become a regular feature of the Group’s activities, and over 50 Witness Seminars have been held, most of which have been published as listed here. Now reconstituted as the History of Modern Biomedicine Research Group at Queen Mary, University of London, and, funded by the Wellcome Trust, this series of meetings and publications continues.
Once a suitable topic has been agreed and academic advisers identified, participants are invited and a flexible outline for the meeting is planned. Occasionally we have had to abandon or postpone meetings at this stage if key people are unable to attend. This is a constant problem when many we invite are elderly. Similarly, some meetings can be disrupted at the last minute by accidents or ill-health: for example, the late Professor Charles Fletcher suffered a bad and incapacitating fall just days before he was due to join Dr Philip D’Arcy Hart as one of the two principal witnesses at the ‘Pneumoconiosis’ meeting. Invitations inevitably lead to further contacts, and further suggestions of people to invite. We rely heavily on such recommendations. As the organization of the meeting progresses, we ask some participants to speak for a short period of time to initiate and stimulate further discussion. Again, these arrangements differ from meeting to meeting, although all speakers are asked not to prepare formal presentations or to show slides, as these disrupt informal interchange.
Thus by the time each meeting is held, it has already developed its own particular shape determined by the participants. For example, no one could dispute that ‘Endogenous Opiates’ would undoubtedly have been a different kind of seminar, not necessarily better or worse but different, if Hans Kosterlitz had been able to attend; or that ‘Monoclonal Antibodies’ would have been markedly different if the National Research Development Corporation had sent a representative who had been personally involved with the patenting issues that were raised.
No two meetings have ever been the same.
As each meeting proceeds it also develops its own kinetics, largely dependent on the personalities of the chairman and the participants, and the relationships among those taking part. Each meeting is fully recorded, and the tapes are transcribed and publication considered. This decision is informed by two main factors – the overall coherence of the meeting, and whether the transcript will contribute new material to the published historical record. Of the meetings held so far, we decided not to publish the proceedings of ‘Renal Transplantation’ or ‘Oral Contraceptives’ because many of the speakers repeated well known anecdotes and accounts, adding little fresh information or interpretation; ‘Pneumoconiosis’ was handicapped by the absence of Professor Fletcher, but has now been partly incorporated into ‘The MRC Epidemiology Unit’; ‘Thrombolysis’ was incomplete, but an extract became an appendix to ‘Platelets’.
Once the decision has been taken to prepare a transcript for publication, a first editorial pass is simply tidying-up. Infelicities, the ‘ums’ and ‘ers’ are removed, and a copy then sent to all participants for them to correct, if necessary, their own contributions. Such amendments are principally stylistic, occasionally misremembered facts – names or dates – are corrected. When all these are returned, which can take several months, all the comments are usually incorporated into the master text. Extensive alterations, or the submission of fresh material, are confined to explanatory footnotes or a glossary. At the same time, we begin to annotate the major reference points alluded to in the seminar, to add biographical and bibliographical details and to continue, if necessary, to edit the text. When this stage is completed the transcripts are again sent to every contributor, accompanied by copyright assignment forms. Once more, any subsequent comments are incorporated if appropriate, or otherwise footnoted. Throughout we are keenly aware that our responsibilities are as editors, not censors, and that our aim is to make the substance of these meetings available to the informed non-expert. Copies of all additional correspondence received during the editorial process are deposited with the records of this meeting in Archives and Manuscripts, Wellcome Library.
Open ‘peer review’
There are also obvious disadvantages to this format. Primarily, the balance of participants is crucial, and there is little we can do if potential contributors are unable or unwilling to attend. Those who do attend may not contribute much, others may deafen with their axe-grinding. One check on the conduct and content of the meetings is the presence of other participants – a Witness Seminar can clearly be seen as a form of open peer review, with all remarks and opinions immediately susceptible to rejoinder, agreement or dispute. Sometimes too, the frailty and variety of individual memory is all too clearly highlighted: an amusing but thought provoking illustration is provided by the differing accounts that emerged during and after the meeting of the ‘Committee on Safety of Drugs’ of the evolution of the yellow card for reporting adverse reactions.
What then do Witness Seminars contribute to the historical record? At a fundamental level they can, and frequently do, serve to guide professional historians through the morass of published and archival sources already referred to, and to alert them to subject matter and sources of which they were unaware; conversely they emphasize to the scientists and clinicians taking part that ‘history’ embraces their working careers. This realization has a number of results – before, during and after meetings we are frequently given documents that are not preserved or accessible elsewhere, and in such instances we always suggest the proper conservation and archiving of the material. Perhaps understandably, it is the less well-known areas that have generated such responses, and many of our witnesses express astonishment at our interest. All such materials will, if not deposited elsewhere, be archived with the records of the meetings and eventually deposited in an appropriate archive for consultation by other scholars.
Hart, P D’Arcy, ed Tansey, E M (1998) Chronic pulmonary disease in South Wales coalmines: an eye-witness account of the MRC surveys (1937–1942) Social History of Medicine 11: 450–468
Medawar, P B (1963) ‘Is the scientific paper a fraud?’, The Listener, reprinted in in The Threat and the glory : reflections on science and scientists, OUP, 1991
Tansey, E M & Catterall, P (1994) Monoclonal antibodies: a witness seminar in contemporary medical history Medical History 38: 322–327
Tansey, E M (ed) (1998) Witnessing medical history: an interview with Dr Rosemary Biggs, conducted by Professor Christine Lee & Dr Charles Rizza Haemophilia 4: 769–777
Tansey, E M (1999) ‘The dustbin of history, and why so much modern medicine should end up there’ The Lancet 354: 811–812
Tansey, E M (2006) Witnessing the Witnesses: pitfalls and potentials of the Witness Seminar in twentieth century medicine. In Writing Recent Science: the historiography of contemporary science, technology and medicine, ed. Ron Doel & Thomas Soderqvist, Routledge, pp. 260–78
Tansey, E M (2008) The Witness Seminar technique in modern medical history. In Social Determinants of Disease eds. H. Cook, A. Hardy & S. Bhattacharya. Orient Longman, pp279–295
Tilli Tansey FMedSci HonFRCP
Professor of the History of Modern Medical Sciences
History of Modern Biomedicine research group
School of History, QMUL