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

tions. James Neel unknowingly prepared for an event that was not supposed to happen: atomic bombs exploding over two major cities. The possible effects oflongterm radiation on a large human population in or near Chernobyl's fallout will draw on his team's contributions to the effect of radiation on future generations. Voles occupying the same area have shown an obvious increase in mitochondrial (and presumably nuclear) DNA damage. Neel had a charmed career. From the coincidence of moving to Wooster, Ohio, where he could walk to Wooster College and an independent research project mentored by an outstanding Drosophila geneticist, Warren Spencer, Neel went to the University of Rochester for a doctoral degree in genetics with Curt Stern. After a postdoctoral experience at Columbia University and the Cold Spring Harbor Laboratory , he decided a doctor would be more useful than a geneticist in an anticipated war. After thorough training in genetics and a medical degree, Neel was probably the most qualified geneticist to evaluate the effects of A-bomb radiation on the progeny of the exposed inhabitants of the two cities. Although the expected surge ofmutants has not yet appeared, the procedures and record keeping by the commission will have value in the future and certainly in monitoring the population exposed to Chernobyl's radiation. After Neel presented the evidence to support a monogenic basis for sickle-cell trait and disease, his pioneering field trips to study the gene pool of isolated Amerindian tribes set the standard for comparable efforts in other parts of the world. His global view of the possible future of Homo sapiens in terms of its gene pool in a rapidly expanding population may some day be seen as a Silent Spring. While his writing style may seem somewhat pedestrian, this autobiography of a pioneer in a field of considerable interest is a fascinating account of preparation and accomplishment . E. D. Garber Dept. Ecohgy and Evolution University of Chicago Technology in the Hospital: TransformingPatient Care in the Early Twentieth Century. ByJoel Howell. Baltimore:Johns Hopkins Univ. Press, 1995. Pp. 356. $47.50. Joel Howell, a physician and medical historian, studied the adoption of medical technology in the Pennsylvania Hospital and the NewYork Hospital during the first decades of the 20th century. His study tries to "lay to rest some persistent myths about the relationship between science, medicine, technology, hospitals and U.S. society." In particular, he argues against the idea that medical technology is adopted only after it is shown to be useful. Instead, he suggests that the adoption of new medical technology is a response to a much more complex set of social, political, and economic forces. Some useful technologies, such as radiographs, were not rapidly adopted. Other technologies, such as repeated urinalyses on hospitalized patients, were rapidly adopted even though they were not obviously useful. The relationship between new technology, new science, and new organizational forms of health care delivery remains relevant. Doctors claimed to be "scientific" •ectives in Biology and Medicine, 40, 3 ¦ Spring 1997 | 457 long before their research met rigorous scientific standards, and hospitals thrived long before the services they provided could be evaluated or shown to be shown useful. Today, activities in the medical sector undergo rigorous scrutiny, but it remains unclear, as it has throughout the 20th century, what evaluative standards should apply and what goals should be sought. Howell argues that the first major transformation of hospitals in the 20th century was not the introduction of new medical technology but the introduction of new accounting techniques. In particular, "Hospital managers began to use cost accounting in an explicit attempt to emulate businesses, including not only railroads but also factories, the arena in which many American at the turn of the twentieth century saw science as having its most visible successes." It was only after hospitals were administratively transformed to resemble businesses or factories that they became receptive and able to profit from new forms of medical technology. By this argument, hospitals consciously created themselves as the image and symbol of science, which they recognized as having enormous marketing value, even before it had any clinical value. "Like the public at large," he notes, "the medical profession saw graphs...