Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (review)

Joel Howell’s Technology in the Hospital is a signal achievement. It takes the general reader, the historian of technology, and the medical historian equally well beyond the traditional “POD” (Physiology, Objects, and Dehumanization) story of modern medical technology. To reimagine the traditional medical technology narrative a newer account should thus transcend physiological lineages of machines, museological gazing upon objects, and the perennial rumble about ethical challenges. Ideally, it would supply the economic and social context within which technological innovation gained acceptance. It should demonstrate the broader currents in business history that swept innovation into view, as well as the local circumstances fostering its acceptance.

Howell adverts briefly at times to the conventional POD formula. But he clearly wishes in the main to emphasize the elements of a broader framework for early-twentieth-century American medical technology, while keeping his overall scope manageable. To obtain such manageable monographic length he has adopted an ingenious approach, one that makes for a largely convincing argument. He lays out his history of technology along three well-chosen axes: conceptual, chronological, and geographic. Along his conceptual axis he arrays certain crucial innovations, focusing especially on urinalysis, the X ray, and blood counts, among what we might recognize as “hard” technologies. At least as important to his argument are the “softer” post-1900 technologies, such as hospital organization, operating room design, and medical records—essentially, the hospital itself—in the elaboration of what would become a new-model American medical practice system after the First World War. Thus his second, chronological axis spans the few key decades commencing with the turn of the century, when Progressive Era norms of efficiency swept across many facets of society. (The accompanying early attempts at the erection of standards, reproducibility, and control represented, he argues persuasively, an early “guidelines movement” [p. 245].)

A third, geographical axis finds the author shuttling between New York and Philadelphia surveying the case records of two hospital organizations (Pennsylvania Hospital and New York Hospital) through the use of rigorous statistical analysis. Howell’s choice of institutions was felicitous in that they happened, on the one hand, to have sedulously maintained patient records, and on the other, to have exhibited both important similarities and key differences in the manner in which they embraced new medical technologies. Within this tidy, cuboidal space of technique, time, and place Howell is able thus to demonstrate his central thesis: that the adoption of technology is shaped differentially by a host of temporal and local circumstances, not determined by some sort of intrinsic technical imperative.

To flesh out his statistical methodological backbone, Howell gives the reader a full menu of telling illustrations (the use of graphic and pictorial materials itself forming a strong point of the book), and anecdote. He provides clinical vignettes describing the Philadelphia man with a fracture who was never X-rayed, or the patient on whom a key test was performed only weeks after admission. And in the case of each technology he goes on to link his narrative of its adoption to the development of medical careers. He depicts men like David Bowen in Philadelphia and Archibald Busby in New York, whose lives and leadership roles in specialty medicine paralleled, exemplified, and harbored the expanding technologies they deployed.

In Technology in the Hospital Joel Howell has taken what one might expect to be a ponderous topic and treated it evenhandedly and rigorously, all in a short and readable stretch. There is little to criticize here. The second of two chapters on X rays, subtitled “Meaning, Gender, and Power,” strikes this reader as somewhat less successful and out of keeping with the rest of the book—a nod perhaps to current trends in historiography not explored elsewhere in an otherwise tightly organized monograph. There are occasional bouts of repetition—pages 127–28, for example, on the radiologists’ struggle to define their consultancy role, recur on pages 159–60—that...