Medica^[1] is a set of online services dedicated to the promotion and dissemination of heritage collections in the history of health. Initiated 25 years ago, it now stands as a case study in sustainability for digital library projects with continuous service that has spanned major technological, organisational, and institutional shifts.

Facts and Figures

Today, Medica offers an extensive collection of digitised materials: 24,000 digitised books totalling 5.25 million scanned pages, 280,000 iconographic documents, 65,000 biographical notes, as well as four critical editions, 15 virtual exhibitions, and 14 partner sites enabling learned societies to establish a presence on the web. It is composed of three main services (Figure 1):

1. A digital library^[2]
2. An image bank^[3]
3. A biographical database^[4]

In 2024, Medica attracted 117,000 visitors for a total of 1,050,000 page views. Nearly half of these visitors were from outside France, even though the interfaces are currently only available in French. The dissemination of our content on other platforms helps to increase its visibility. There were 326,000 page views during the year on the Internet Archive and, within the Wikimedia ecosystem, 21 million page views in 2024 included content from Medica.

In the context of French higher education, these figures are substantial, positioning Medica as a first-rate platform for knowledge dissemination, particularly in terms of data volume. This scale is largely due to Medica’s longevity as the Paris Interuniversity Library of Health (Bibliothèque interuniversitaire de Santé – BIU Santé), with its staff of around one hundred, has operated with far fewer resources than major institutions such as the French national library (Bibliothèque nationale de France).

Historical Overview: Origins in the Late 1990s

Medica’s origins trace back to the Interuniversity Library of Medicine (Bibliothèque interuniversitaire de médecine – BIUM), a successor of the mediaeval library of the Paris Faculty of Medicine. In the late 1990s, BIUM launched its digitisation efforts, leveraging decades of expertise in document photography. The library established its first website in 1999, alongside a pioneering virtual exhibition and the initial version of its image and portrait bank.

The following year, three years after the creation of Gallica,^[5] the digital library was launched, taking advantage of the experience gained with the image bank, and the name Medica appeared. At the same time, the first partner sites emerged, and other small databases were made available to the public. The aim was to use the web to structure the documentary offering on the history of health around the library and to adapt to the anticipated decline in physical library visits.

Late 2000s

In 2006, the Paris 5 University, which gives the library servers access to the web, rebranded itself and changed its name to Université Paris Descartes, leading to a change in the Internet domain name of Medica.

By the late 2000s, the number of partner websites increased, as did the number of collaborations with learned societies. An editorial function naturally emerged, namely putting the abstracts of journals published by these societies online.

A biographical database devoted to the history of healthcare was added to the core of the service package. This database aimed to make the most of the work carried out in-house to locate and analyse documents. It not only provided information on individuals but also – most importantly – listed sources to which researchers could refer.

2010s Growth and Partnership Evolution

In 2011, the BIUM merged with its sister library, the inter-university library of pharmacy, and it became the BIU Santé (Interuniversity Library of Health). For several years thereafter, the volume of databases and the number of digitised documents, partner sites and virtual exhibitions continued to grow.

Fruitful relationships were maintained with researchers, particularly through the provision of partner sites, collaboration on virtual exhibitions,^[6] and publication of scholarly presentations^[7] introducing the digital library’s collections. These researchers did not hesitate to propose daring projects to the institution. The relationships led to the development of three online critical editions (a fourth is to follow in the 2020s),^[8] which were distinguished by their critical apparatuses.

The range of online services was also quite diversified. A blog was created to promote the services and better meet the needs of the users. The online communications strategy was fleshed out, structured, and deployed jointly on social networks, particularly on X (formerly Twitter).

Late 2010s

The system of partner sites began to slow down, and, taking advantage of the development of new tools and new hosting methods, several learned societies left the BIU Santé IT fold and launched independent websites. The range of data on offer continued to grow, and a new activity emerged: the dissemination of content on recognised platforms. Major partnerships were forged with the Medical Heritage Library (Boudon-Millot & Vincent, 2020) and Wikimedia (Benoist, 2020), leading to the full inclusion of Medica’s digitised documents in the Internet Archive and targeted uploading projects to Wikimedia Commons and Wikidata, which are distinguished by the structuring of their metadata.

The end of this period also saw the completion of a major project, the online publication of the ‘Métadictionnaire’^[9] an interface for exploring old medical dictionaries using structured metadata derived from automated recognition of the lexical relations mentioned in these works, such as synonyms, translations and locutions. Following the example of online critical editions, this project was proposed by a researcher who was a regular user of Medica and familiar with the institution’s activities and expertise.

Finally, around 2020, a major merger took place. The BIU Santé Library, Paris Descartes University, and Paris Diderot University joined forces to create a new institution, Université Paris Cité, which gave Medica a new graphic identity and governance, paving the way for its integration into a brand-new platform, Numerabilis.

Challenges in a Nutshell: Technological Issues

It is difficult for a service package to stay afloat over a long period in a constantly changing environment. From a technological point of view, it would have been very surprising if the technical choices made in the 1990s were still all relevant today.

Apart from the adaptive maintenance through version upgrades that all IT construction undergoes, the programming language used at the origins of Medica has now been abandoned. This has led to applications being rewritten in languages that are still in use. Similarly, the choice of FileMaker database systems, which may have been suitable for modest projects in the 1990s, proved unsuitable for the scale Medica took on in the 2000s. Lastly, this development by successive accretions of services naturally has generated complications: redundancies have appeared (such as the multiplication of zoom systems among applications or the multiplication of different image formats), the increasing heterogeneity of data has made archiving more difficult, and, above all, documenting and maintaining knowledge of the service package has become a real challenge.

Beyond software engineering, the global technological environment has also changed considerably, and the development of online services and the emergence of global standards are leading to further obsolescence. Hosting partner sites in HTML, which was a useful proposition 20 years ago, has now been marginalised by the rise of site factories and other CMS hosted in the cloud. At the same time, the development of reference databases, supported by the widespread use of recognised identifiers (IdRef^[10] in France, VIAF, Wikidata), is calling into question the redundancies created by the existence of local databases. New protocols such as IIIF are rendering obsolete the old ad hoc systems for zooming or displaying images online.

Organisational Issues

The institutional instability in French higher education must also be considered (Bézagu et al., 2019; Musselin, 2022; Aimé, 2023). The identity of the services offered on the web is itself being challenged. The names of the supervisory institutions and, consequently, the Internet domain name where the package of services is positioned have changed several times over 13 years (e.g. bium.univ-paris5.fr, bium.parisdescartes.fr, biusante.parisdescartes.fr, u-paris.fr). We have learnt that the services and missions offered to the public live longer than the administrations that manage them and that, to develop their reputation over the long term, it can be useful to give these services a distinct name.

These institutional developments are also changing the composition and versatility of the teams. The BIU Santé used to be an autonomous establishment, which had to manage – in good times and bad – Medica in all its aspects (documentary policy, communication strategy, IT maintenance, provision of infrastructure, digitisation capabilities, and signing of agreements with partners). This management required teams to be highly versatile. Integration into a larger structure, the Université Paris Cité, has profoundly altered scopes of responsibilities. Teams are becoming more specialised, and there is less intermingling of different professions.

The pooling of resources at the university level solves some of the problems mentioned, such as the difficult maintenance of the technical infrastructure, for example, but it also brings its own challenges: more complex decision-making processes and dispersal of expertise across different departments slow down the conclusion of partnerships and the launch of new projects, and pooled communication tools and media limit the specificity and agility of communication around Medica.

Achievements Beyond the Obstacles

These challenges can provide considerations about the long-term management of this kind of construction. However, it would be misleading to stop there. The efforts made to enable Medica to triumph over these obstacles are fully justified, and the overall results are positive.

The figures provided at the beginning of this paper show that these services are being used. They are also recognised and have enabled their parent establishments to obtain official recognition, including the Culture Libre label,^[11] the Plottel prize,^[12] and subsidies from national programmes.

They have helped to forge long-term relationships between librarians and researchers, as well as with other institutions, both nationally and internationally. In turn, they have sparked new projects and partnerships.

Looking Forward: Integration into Numerabilis

In 2023, the Department of Libraries and Museums at Université Paris Cité launched a project to develop Numerabilis. This university-wide digital library ecosystem has been scheduled for launch in 2025, and it will integrate and extend the services offered at Medica beyond its disciplinary perimeter.

Numerabilis will have to be sustainable and technically extensible; it will have to enable the editorialisation of resources, raise the profile of collections, and promote research on them. It will make possible the publication of new collections from a variety of disciplines beyond medical sciences: (hard) sciences, societies, and humanities. New types of resources will be published, including museum collections, objects, archives (both scientific and administrative), and audiovisual materials. The Museum of History of Medicine in Paris, for example, will soon be equipped with a collection management tool, and its data will be harvested by the platform to create a public catalogue.

The future platform is based on open technologies and standards. The Omeka S software (developed by Digital Scholar) is the central building block, combined with the Solr search engine, Cantaloupe IIIF server, and Mirador viewer.

Following the principles of the Web of Data and in the interest of future-proofing, metadata will be described exclusively using RDF vocabularies and will be enriched from global authorities’ repositories (IdRef and more).^[13]

To date, the target architecture has been defined, the new infrastructure has been set up, and the data model and mapping have been outlined. The coming year will see all the stages unfold. These changes will start with the transfer of the Medica ecosystem’s applications, services, and data to the new infrastructure hosted by the IT department of the university.

Thereafter, Medica data will be migrated and enriched in Omeka S. New collections, such as serials and museum objects, will be added in parallel. A major task will be to create a front end that complies with current web standards and the university’s graphic identity. Finally, all workflows, from resource selection to digitisation, publishing, and promotion, will be reviewed to ensure maximum consistency.

Conclusion

Medica’s trajectory over the last 25 years illustrates the complexity of managing a long-term digital asset project in a constantly changing technological and institutional landscape. With its integration into the Numerabilis platform, we expect that Medica’s resources and contributions will be extended in a broader, interdisciplinary framework. We hope that this example of Medica’s development offers a practical perspective on the sustainable management of documentary heritage services offered to the public.

References

Abstract

Medica is a long-standing digital library dedicated to the dissemination and preservation of heritage collections in the history of health. Established over 25 years ago, it serves as a case study in sustainability for digital library initiatives, adapting to technological, institutional, and organisational shifts. The platform provides access to 25,000 digitised books, 280,000 iconographic documents, and a biographical database of 65,000 entries. Over the years, Medica has expanded its services and content and developed scholarly partnerships.

Medica has faced significant challenges, including evolving software infrastructures, shifting institutional affiliations, and the increasing complexity of maintaining interoperability with global databases and web standards. Despite these obstacles, its contributions have been widely recognised, fostering collaborations between researchers, librarians, and cultural institutions.

Medica is currently undergoing a major transformation with its integration into Numerabilis, a new interdisciplinary digital platform at Université Paris Cité. This transition leverages open-source technologies, linked data principles, and advanced metadata management to ensure long-term sustainability. The new ecosystem will extend Medica’s scope beyond medical sciences, incorporating diverse heritage materials such as museum collections and audiovisual archives.

Medica’s evolution highlights both the challenges and opportunities in sustaining digital heritage initiatives within an ever-changing landscape. Its journey offers valuable insights into the resilience and adaptability required for long-term digital resource management.

Keywords

Academic libraries; Heritage collections; Digitisation; Digital library; Data dissemination; Health history