Hoffman 1-5

This section began by discussing the problems the Great Depression brought to healthcare by hindering the patients payment to doctors.  I found it interesting how these drastic times basically started the discussion of universal health care as a right.  This section also mentioned that universal healthcare was brought to discussion but it took a back seat to the fiscal issues.  The following chapters then described the schism between private and public healthcare, and how hospitals could even have the right to refuse people who were unable to pay.  I found it impossible not to sympathize with the victims in some of the examples of people getting turned away by hospitals.

Howell chs 6-8

This section of the book both focused on the emergence and use of the blood test and summed up the major trends cited in earlier chapters with chapter 8.  Chapters 6 and 7 first described how the blood count emerged and evolved, then cited the 3 diseases that it was especially used for: pneumonia, typhoid, and appendicitis.  The chapters also dealt with the timespan it took for the blood count to be regularly used.
Howell cited the frequencies that each test was given at the Philadelphia and the New York hospitals. He mentioned that the inconsistent implementation of the blood test was due to doctors' personal preference their diagnosis. Many doctors felt they could evaluate blood with the naked eye better than they could by counting through a microscope.  This point culminated in the description of the debate between hematologist John Da Costa and Surgeon John Deaver. Da Costa advocated new school lab diagnosis while Deaver felt his intuitive diagnostic skills could only be impeded by time taxing lab tests.
Although Dr. Deaver's point of view may produce some questions about physicians egos it also suggests that many of the costly test done in our present healthcare system are arbitrary and unneeded. Howell further supports this by stating the New York hospital, in progressive era style, tested for everything regardless of the condition by using a standardized form.  Howell concludes the book on this note by stating the most important technology in hospitals today are still the ones with communicating and business purposes.

CH.3-5 Technology in the hospital

In chapters three through five the book discusses the increase in the use of tests in the hospital by describing the changes in urinalysis and the use of the X-ray machine.  The urinalysis had been used since maybe the 15th century; however it was modified in the early 19th century.  Aside from color and specific gravity people also began testing for things like sugar and urea.  This was made more efficient with the use of new centrifuges. When the author showed the frequency of each test, urea was shown to be rarely tested on.  The author seemed to have no conclusive reason for the sparsity of this test, but he suggested it was just up to how partial the physician was to performing the test.  This was interesting because, in light of the recent publication claiming the urea test's usefulness, it showed the reality of how new discoveries don't always result in immediate application.  

This reading also revealed how new tests and machines, such as the X-ray and the new urinalysis, forced many patients to become dependent on hospital care as opposed to care at home. X-rays and lab equipment were near impossible or inconvenient to bring to the home so, despite transportation issues, most patients needed to be in a hospital for these tests.

  It was also strange to learn that women were less likely to receive X-rays than men.  The author suggest it may be the result of the different lifestyles the two genders led, citing facts such as men were more likely to be hospitalized for trauma than women.  Still, with the unsafe nature of the X-ray it was suggested that maybe physicians assumed women would react badly to the scary machine and possibly pursue legal action on the hospital.  This is plausible with the given example of the women and her child getting knocked down by a spark from the machine, but it still shows the sexist assumptions of the times.  Aside from the negatives, these tests and machines allowed the physician to further objectify himself from body examinations and improve diagnoses.

Technology in the Hospital CH 1&2

The first chapter of this book read like an abstract of a scientific paper; it was mostly concerned with outlining what the book would explore.  The author also used a fair amount of graphical data in making his points.  Most of them showed how hospital use and organization trended from 1900 to 1925.  In relation to graphs, one of the authors main topics in the second chapter was the evolution of record keeping in the hospital.  This became more efficient with standardized forms and typing and calculation machines.  These improvements were vital in the wake of Americans transitioning from home-care to hospital care, which we were introduced to in Marrow of Tragedy.
With this increased use, I was surprised at how the hospitals image changed as paying middle to upper class people began frequenting the hospitals.  It seems this was what spurred the money centered system of healthcare we still see today.  With this business-oriented hospital it was also surprising to see the heightened importance of administrators.  This translated in the latter part of Ch.2 in the description of the "efficiency craze", where people began to use quick and efficient business practices to allow for quicker surgeries so the hospital could have more vacant beds resulting in more money.