Devices and Designs: Medical Technologies in Historical Perspective (review)

Devices and Designs is an edited collection of historical studies of medical technologies originally presented at a University of Manchester conference in 2003. Edited by Carsten Timmermann and Julie Anderson with a foreword by Thomas Hughes, the book brings order and insight to a two-century historical movement in Western medicine to integrate science and industry into medical practice. It focuses on the history of this interaction through approaches that range from biographical sketches to studies of innovations to more critical essays on medicine's social impact. Hughes organizes them around their pragmatic societal role. The insight one gains from studying this interaction, he believes, better serves practitioners and the public to "take action, improve practice, and make policy" (p. viii). This insight is still important, and Devices and Designs traces this centuries-old historical movement in Western medicine by focusing attention, in Timmerman and Anderson's words, on "the devices and designs that transformed medicine" (p. 1).

In their introduction, the editors note that medical technologies are synonymous with medicine. New medical technologies mark changes in medicine over the past two centuries. The centrality of technology in historical accounts of medicine makes them the most likely candidates for study in fields varying from the history of medicine and the sociology of health and illness to science and technology studies. The contributors to this book represent this eclecticism. It is organized into three sections: technical innovation and the emerging economies of modern medicine; context, contingency, and the life stories of technologies; and expectations, outcomes, and endpoints.

The contributors to the first section deal with the emergence of techniques and technologies that shaped modern medicine over the past two centuries. Chapters by John V. Pickstone and Christopher Crenner focus on innovation through biographical sketches of craft families and individual practitioners to illuminate the choices both groups made to adapt to changes in medical practice. Jonathan Reinarz's chapter on innovations at Birmingham voluntary hospitals reveals an ad hoc sociotechnical network of practitioners, donors, and techniques all contributing to a uniquely localized process of medical innovation. Peter L. Twohig's chapter on the introduction of X-ray machines in Canadian hospitals demonstrates how technologies can introduce ambiguity into the organization of hospital work through the redistribution of expertise.

The contributors to the second section offer historical studies of medical innovations. Neil Handley's historical overview of innovations in prosthetic eye manufacturing addresses the objects' significance both as art objects and as medical devices. Chapters by Patrik Hidefjäll, Takahiro Ueymana and Christophe Lécuyer, and Carsten Timmerman all focus on the influences that basic research had on medicine after World War II. Julie Anderson's chapter on the development of clean-air enclosures for hip-replacement surgery show that it represented both an attempt to reduce associated infection rates and to address bacterial resistance from the overuse of antibiotics.

The contributors to the final section address the unintended consequences of medical innovations. In a fitting complement to Anderson's chapter, Robert Bud addresses how bacterial resistance turned from a concern for hospital administration into a political issue in England. Gerald Kutcher looks at the ambiguities arising from standards-setting in clinical trials, which are issued through protocols that, to be successful, must include some flexibility. Sally Wyatt and Flis Henwood look at patients' frameworks for understanding menopause and the risk of medical treatment in their choices concerning hormone replacement therapy. Stuart Blume considers how new technologies, when framed as unmitigated social goods, acquire that value from their producers while ignoring those of the populations for which they were designed.

Devices and Designs represents scholarship from a variety of disciplines, none of which necessarily speak to each other but all of which historically situate the role of innovation in current medical practice. The book contributes to an understanding that medical innovations are local phenomena whose meaning and use are attuned to that locale. It illuminates the formation of the technical codes that...