Medicine and Technology

MEDICINE AND TECHNOLOGY JONATHAN M. UEBENAU* Debates over the role of medical technology have been raging in public and professional circles for the past 20 years. The history of medicine and technology, however, has not reflected the depth of contemporary interest in the subject. And where historians have looked at medicine and technology, they have often taken a rather limited approach. Historians of many descriptions have studied medicine, and currently there is a boom in the social history of medicine, especially of the nineteenthcentury English-speaking world. Although they have used techniques from other areas of history, medical historians have generally not borrowed from the history of technology. However, now that historians are studying technology from a perspective broader than merely considering the form and development ofmechanisms, we could apply these new modes of analysis to the history of medicine and go beyond the limited issue of the use of instruments and tools. Despite the potential of these approaches, however, only a few writers have begun to take up this work. Stanley Reiser, whose Medicine and the Reign ofTechnology provides a review of diagnostic technology and a critique of its overuse, is now perhaps the best known of such historians [I]. Audrey Davis covers a wider range of topics in her book on the history of medical technology [2]: she has defined medical activity broadly as technique and technology , viewing modern medicine as a set of skills often based on or reliant on instruments. There are a number of ways in which we can speak of medicine and technology, ranging from the effects of modern life on epidemiology to the conception ofparticular organs and bodily functions in technological terms. For the sake of simplicity, I shall separate them into four general classes. The first consists of the health consequences of the fundamental technological changes which we associate with urbanisation and industrialisation . The second includes the way in which medical practice has * Business History Unit, London School of Economics, 10 Portugal Street, London WC2A 2HD, England.© 1983 by The University of Chicago. All rights reserved. 0031-5982/84/2701-0369$01.00 76 I Jonathan M. Liebenau ¦ Mediane and Technology been adapted to technological society, and, in particular, how new tools and techniques have been developed and used. In the third, I will look at medicine itself as a technological system, influenced both by the new technological styles of management of the last century and by the "imperatives " of the efficient use of hardware. Finally, there are a number ofconceptual alterations which can be associated with technological ways of thinking. These include models of structure and function that were either derived from an engineering image of the body or were used as explanations for systems oftreatment and practice. These categories are not exclusive, and the examples I present are intended simply to illustrate how we may view particular issues from this perspective. I The most profound effects of technology on medicine are not, surely, the availability of heart transplants or radiographs or even entire hospital complexes, but the epidemiological changes brought about by industrialisation . Disease patterns have been radically altered by modern city living and by factory work. While the urban plagues of cholera, tuberculosis , and diphtheria are numerically the most significant, the clearest examples are from industrial accidents. This can be seen in the case of railway injuries. It took generations to adjust to inexorably moving machinery , and with the widespread use of heavy equipment, in particular on the railways, the incidence of compound fractures rose significantly. This problem encouragedJoseph Lister to concentrate on the difficulties of wound healing, resulting in his work on antisepsis [3]. Railway accidents were classed separately in many hospital patient lists, and the London Times kept an almost daily column for such reports. In the mid 1860s a debate was raging about the medical character of railway accidents , fuelled in part by resultant lawsuits.1 Such cases were among the first in which expert testimony was presented in British courts. In one celebrated instance in 1867, a half-dozen prominent London physicians and surgeons were matched againstone another to debate the legitimacy of a £12,000 claim after spinal injury. Juries usually did award compensation...