Based chiefly on material from primary sources, this book describes some technological advances made in the art and practice of medicine during the past three centuries and shows how these advances have altered the methods of diagnosing illness.
Reiser's scholarly study documents the pendulum-swinging characteristic of medical tradition. In a century and a half, physicians have gone from a hands-off-the-patient attitude (ungentlemanly, distasteful, likely to stamp one with those menials, the barber-surgeons) to one in which no part of the patient's body is inviolate. Tissue is pummeled and probed and samples are parceled out to this or that lab for automated data readouts. How this happened is deftly told in Reiser's chapter-by-chapter account of the pioneers and the controversies surrounding the introduction of the stethoscope, the blood pressure cuff, microscopic studies, X-rays. . . down to the latest computer programs for making a differential diagnosis. Some of the earlier case histories are distinguished by eloquent descriptions: Laennec, the inventor of the stethoscope, wrote that the chest sounds of a tubercular woman were like "a gnat buzzing in a porcelain vase." Reiser also relates that doctors in the pre-black bag days had trouble devising ways of carrying their new equipment. "One Edinburgh medical student was accused of possessing a dangerous weapon when his stethoscope fell from his top hat during a snowball fight." As we have come full swing in the technological cycle, reaction has set in. While some doctors fear replacement by computer, others have pointed to the alarming lack of standards and quality control in clinical laboratories. Still others argue for a restoration - a swing back to a more personal doctor-patient relationship in which doctors listen to what patients say with an attentive and sympathetic ear. Reiser agrees. Accurate, efficient, and reliable machine results should be a part of standard medical practice, but they should not come at the price of ignoring human factors. Reiser writes well and his thoughtful analysis highlights an important aspect of medical history. The book is replete with notes and bibliography befitting its depth and breadth. (Kirkus Reviews)