Lectures notes- winter part 2.docx

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15 Apr 2012
Fighting Disease with Medical Technology March 14
Defining Medical Technology
The Introduction of Medical Instruments and Machines (late 19th
o Extending the physician’s sense: The Stethoscope
o Technology in the Hospital: The X-Ray
Disease Experiences with Medical Technology (early 20th century)
o Tuberculosis and Fluoroscopy
o Cancer and Radiation Therapy
o Polio and the Iron Lung
The “Reign” of Medical Technology Reassessed
Rene T.H Laennec (1781-1826)
Wilhelm C. Rontgen (1845-1923)
Defining Medical Technology
How are machines used over time?
What meaning do we assign to technology?
Historically and culturally contingent
Who is promoting/ funding the machine?
Not all machines introduced in practice because of political, social,
cultural factors
Machines can have more than one meaning beyond what was intended
How has medical technology altered our concept of disease and how do
we go about fighting disease and why?
Medical technology:
Broadly defined medical technology encompasses the instruments,
devices, machines, drugs, and systems developed for medical
research and/or clinical practice
Most historians agree that the process of innovation is not one way, linear
progression; rather multi directional, incremental, serendipitous, circular
New medical technologies not adopted because it was superior than
previous technology, many other factors
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Technological determinism- many scholars argue this is not a way to
understand technology, it is not inherent in shaping society, political, and
social factors shape technology and our understandings
19th century Medical Instruments and Machines
Oldest diagnostic instrument probably the vaginal speculum (dates back
to Rome)
In the 18th century a primitive stethoscope was created however it was
not used in day to day treatment
In the 19th century technology was designed to understand what was
happening within the body
Previously studied dead bodies but doctors wanted to see inside living
Instruments were seen as extension of physicians senses (see, hear
inside the body)
Physicians eager to expand their ability to diagnose and treat their
patients, initial acceptance of new instruments and tools to gain this
Stethoscope 1819
Invented by Rene Laennec
Beginning to understand respiratory diseases at this time, the
stethoscope greatly helps this understanding
Laennec born in western France, orphaned at young age, raised by
two uncles (one priest and one physician)
enlisted as surgical aid in the army at 14
In early 20’s he had considerable experience and knowledge, went
to Paris to study under masters
1816- lands an official position at the prestigious Necker hospital
o he gained this position after the Restoration of the royals in
1815, shows that he was a royalist
when treating a “stout” woman with heart problems he was unable
to hear he heart with percussion techniques, thought placing his ear
on her chest would let him hear better
o because of decorum he rolled up a paper into a cylinder which
increased his ability to hear her heart
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spends years interpreting sounds he can hear through the tube,
comes up with new vocabulary to describe the sounds (ex. murmur,
1819 writes his book that supports that explains normal and
abnormal chest sounds, encourages use of the cylinder
work gets lots of attention, many students want to work with him
also lots of criticism, goes back and revises his book in 1826
o shows that physicians were seeing usefulness of the tool and
wants clarification and revised models
dies soon after his revised edition however the stethoscope is
refined and still in use
impact of the stethoscope
o first diagnostic instrument to gain rapid international
o allows physicians in gain a better image of the inner living
body through sound
o diseases and abnormalities are identified
Invented by British Benjamin Babington
Tubular tool that allowed the physician to see past the tongue down
the throat
By early 20th century physicians started to use this as means to
intibate the larynx
Used to examine the interior of the eye
Allowed the operator to treat as well as diagnose
Particular specialties start to form around this instrument
o empowers the physician, they can not only see but operate on
the eye
the microscope an example of incremental change, constantly improving
Shift from individual tools to machines in the hospital
Large machines that are too expensive, cumbersome for doctors to
Require special training, start of specialists who are experts in
working with specific machines
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