By Diane Swanbrow
U-M News and Information Services

In November 1895, German physicist Wilhelm Conrad Roentgen was experimenting with electrical current in a cathode-ray tube he'd placed inside a black cardboard box. He noticed that when he passed the current through the tube, a nearby screen glowed with an eerie fluorescent light. Roentgen had discovered a form of radiation that could penetrate solid objects to create a photographic image. Because the radiation was a mystery and 'X' represents the unknown, Roentgen called his discovery X radiation.

On New Year's Day in 1896, Roentgen mailed an X-ray picture of his wife's hand to a number of his colleagues--dramatic evidence that he had devised a means of seeing inside the human body. This image and many similar X-ray pictures were soon seen by people around the world, and the new technology slowly evolved into medicine's first widely used high-tech diagnostic tool.

Today, medical tests and technologies far more complex than X-rays have become a routine part of health care. From mammograms and blood tests to CAT, MRI and PET scanners, machines and technologically intensive procedures can sometimes help physicians detect diseases early and prolong lives.

It's hard not to feel thankful for all the benefits technology has brought to medical care. Still, some people are starting to question whether machines are getting in the way of one of medicine's major goals-easing the suffering of sick people. Do medical machines work as well as they're supposed to? Are they worth what they cost? Are they distancing doctors from their patients, supplying so much precise, numerical information that no one pays much attention to what sick people say they are feeling about their illness?

Joel D. Howell, an associate professor of internal medicine, history and health services management and policy at the U-M, raises these and related questions in his book about the American obsession with medical technology, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century, to be published this summer by the Johns Hopkins University Press.

"In order to understand how we came to a state of affairs in which an overuse of machinery has made many physicians better scientists but poorer healers, we have to step back and realize that technology isn't driving us, we're driving it," says Dr. Howell, who directs the U-M Program in Society and Medicine and is co-director of the Robert Wood Johnson clinical scholars program here.

While measuring the extent to which technology dominates modern medical care is trickier than it might seem, Howell notes, some economists claim that between 30 and 40 percent of the increase in health care costs over the last few years can be attributed to medical technology. At the beginning of life, in the treatment of premature babies, and at the end of life, 'in the treatment of the terminally ill and aging, technology often looms especially large. But even in between those two extremes, Howell points out the routine use of high-tech screening devices makes technology a constant if not necessarily useful part of today's medical treatment.

Howell's book illuminates the social and historical context surrounding the ascent of medical technology. He does this by analyzing patient records between 1900 and 1925 at Pennsylvania Hospital, the oldest hospital in the nation (founded in 1751), and at New York Hospital, which opened its doors 40 years later. Both institutions bought X-ray machines shortly after they were invented, but did not routinely use them for about 20 years. Howell contends that the history of how X-ray machines came to be used, first slowly, then routinely, reveals a great deal about the sources of contemporary society's obsession with medical technology. His book provides a perfect occasion to reexamine medicine's past, since this year marks the 100th anniversary of the X ray's discovery.

"The social response to the X-ray machine was astonishing," Howell says. "People lined up for one hour sittings to view their own bones. Coin-operated machines let people glimpse the insides of their hands and feet. Wealthy young women had X-ray pictures taken of themselves holding hands with their betrothed."

Noted authors gave the X ray a central place in their work. In Thomas Mann's The Magic Mountain, Howell points out, the protagonist Hans Castorp "is enamored of the X-ray image of his beloved, who is in a TB sanatorium. In one scene, Castorp is described as drawing out 'his keepsake, his treasure ... a thin glass plate, which must be held toward the light to see anything on it. It was Claudia's X-ray portrait, showing not her face but the delicate bony structure of the upper half of her body, and the organs of the thoracic cavity, surrounded by the pale, ghostlike envelope of flesh. How often had he looked at it, how often pressed it to his lips.'"

But the invasive power of the X ray tended to stir more fear and repulsion than desire in the real world. "Coming close upon the heels of other technological inventions of the period, including the telephone and the photograph," Howell notes, "the X ray was sometimes viewed as evil in its ability to, in the words of one critic, 'render privacy a mere tradition of an unscientific past.'"

But at the same time, Howell says, X-rays solved a problem of male physicians of the same era who wished to care for female patients. "Male physicians were allowed to examine women, as long as they didn't look," he says. "The gaze was a far more potent cultural symbol of eroticism than the touch." Even though the X ray compromised a woman's modesty and privacy, it allowed male physicians to examine women without directly looking at them.

"At about the same time as the X ray and other medical technologies were becoming widely used," Howell says, "the percentage of American physicians who were women was higher than it would be again for a long, long time. The percentage of women physicians peaked in Boston at 18.2 percent in 1900 and reached 6 percent in the country as a whole in 1910. 1 can't help but wonder if the introduction and widespread use of machines after 1900 played a role in discouraging women from entering medicine."

Howell wonders "if the fact that medicine became even more male-dominated in the ensuing decades made it even more likely that machines would be used. Even by the turn of the century, popular fiction often portrayed doctors as technology-based, obsessed with time-management, utterly uninterested in the empathetic aspects of medical care and clearly male."

Howell says that "some people think that men tend to objectify the world, to see it in terms of numbers, while women tend to see the world more as a unified whole." If this is so, he suggests that as women re-enter the medical mainstream, "compassion and care may assume more importance, and the hard data supplied by sophisticated technological devices will serve only as a useful indicators rather than the last word on how any given patient should be treated.

"People are always making choices about how to use technology, and if we're using it in ways that alienate patients and interfere with the healing process, that's our fault, not a flaw that's built into the machines themselves."

If technology has come to dominate medical treatment today, he concludes, "then it is because people have decided that technology is the most important means of obtaining information that can help those of us who are sick. Sometimes technology is essential for helping patients. But technology can impede as well as enhance health care, and we as a society will ultimately decide the proper place of medical technology."