The limestone caves of Stoney Middleton Dale are a Site of Special Scientific Interest (SSSI) for features of geological interest, but have been open access since at least the eighteenth century and have a documented history of geotourism. Using the examples of Carlswark Cavern and Merlin Cavern, this chapter sets out evidence that 300 years of open access has resulted in significant disturbance to the features of geological interest. In particular, the integrity of the overall site for scientific research was affected by historical removal of speleothem formations long before it became a SSSI, with damage still occurring today. As most cave SSSIs in Derbyshire have historically had similar open-access arrangements, the examples presented highlight that there is potential for the integrity of less well historically documented caves elsewhere to have been disturbed. This article highlights the importance of establishing a baseline of historical disturbance to recognize whether the integrity of cave SSSIs have been affected and help monitor if disturbance is still occurring. For cave SSSIs to be useful for geological research, it is suggested that there is a need for the historical legacy of open access to individual caves elsewhere to be better understood.