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• W4366809985 abstract "770 Book Reviews TECHNOLOGY AND CULTURE Technology in the Hospital: Transforming Patient Care in the Early Twentienth Century. By Joel D. Howell. Baltimore: Johns Hopkins Uni­ versityPress, 1995. Pp. xv+341; illustrations, figures, tables, appen­ dices, notes, index. $47.50 (hardcover). During the first two decades of the 20th century, the American hospital evolved from a benevolent institution that served lower-class patients and elite physicians to a medical workshop that served pa­ tients of all classes and a broader cross section of physicians. This modern hospital was to become central to medical education, medi­ cal care, and clinical investigation. Medical historians have attrib­ uted the transformation of the hospital to factors both internal to medicine (such as the growth of medical technology, the rise of sci­ entific medicine, and reforms of medical education) as well as fac­ tors external to it (such as urbanization, immigration, and industrial­ ization). Previous accounts have concentrated on the impact of medical technologies, such as Wilhelm Roentgen’s 1895 discovery of x rays, as a major force in this transformation, suggesting that physicians readily incorporated them into their hospital practices. In this bookJoel D. Howell, a physician and medical historian at the University of Michigan—Ann Arbor, primarily focuses not on the machines but on the social contexts in which they were developed, defined, and applied. In 1900 the clinical exam dominated medical decision making. Although some laboratory tests existed, such as urinalysis and x rays, they rarely influenced diagnosis or therapy. By 1925 medical care was dominated by science and technology. Howell examines the fac­ tors behind this change by analyzing case records from 1900 and 1925 at two hospitals, Pennsylvania Hospital in Philadelphia and New York Hospital in New York City. Howell begins his book with an examination of how the ideals of the Progressive Era influenced hospital organization and medical practice. He argues that business technologies more than medical ones prompted the transformation of the hospital. As hospitals grew in scale they developed new administrative units, introduced ac­ counting techniques, and embraced standardized recording—all hallmarks of the efficiency movement and scientific management. Howell contends that the reorganization of the hospital along the lines of a factory was a prerequisite for the reception of medical technology. Hospitals needed efficient systems to manage the com­ plexity of the operating room and the x-ray lab. Howell spends the bulk of the book comparing the use of three medical technologies—urinalysis, x ray, and blood counts—at the two hospitals. The analysis of urine was a part of physicians’ arma­ mentarium at the turn of the century. By 1925, the meaning and clinical uses of the test had changed. It had moved from an admis­ sion ritual of litde utility for patient care to an important gauge of TECHNOLOGY AND CULTURE Book Reviews 771 specific clinical conditions. Howell ties this evolution, in part, to phy­ sicians’ traditional familiarity with the test, to the increased precision and scope of the technique, and to simultaneous reforms in medical education that emphasized laboratory-based medicine. Howell makes plain that the utilization of technology by physi­ cians was a socially negotiated process and that tensions often devel­ oped over its adoption. X rays were initially seen as a medical curios­ ity rather than a diagnostic and therapeutic tool. It took more than two decades after both hospitals purchased x-ray equipment before physicians began to use it routinely even for fractures. Some physi­ cians resisted the introduction of medical technologies, such as blood tests to evaluate appendicitis, because they feared that their use might devalue the status of physicians whose expertise lay in clinical skills rather than in technical ones. Howell also found re­ gional differences in the application of technologies—a finding that underscores the importance of analyzing technology within a social context. For example, at Pennsylvania Hospital women were signifi­ cantly less likely than men to receive an x ray, while the opposite was true at New York Hospital. Local medical culture and experi­ ences likely account for the variation. The use of patient records is the greatest strength of Howell’s book. It allows him to look beyond physical artifacts as causal agents in..." @default.
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• W4366809985 title "Technology in the Hospital: Transforming Patient Care in the Early Twentienth Century by Joel D. Howell" @default.
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