Medicine in the News Book

The author seems to have had a bug up his ass, but there is a lot of interesting stuff in this 1995 publication from Johns Hopkins press. He compares a random sample of patient records from the Pennsylvania and New York Hospitals between 1900 and 1925 to look for changes in medical technology. In particular he looks at the frequency of order and apparent indications for urinalysis, radiographs and blood counts. In brief, their use went way up. At the turn of the century doctors saw no need to x-ray a fracture or examine blood. Urine was examined relatively frequently, but over the years the examination became standardized and pre-printed forms became common. Measurement of urine urea content, for example, became less common (since it is worthless). Interesting discussions include: the amazing quickness with which hospitals bought x-ray equipment after Roentgen discovered the ray (its operation was the job of the chief resident!), the development of the differential white blood cell count (check out Gibson's article in the Annals of Surgery, volume 43, April 1906, p. 485), a test that I've never heard of in which a blood smear is placed over iodine fumes and the leukocytes are examined for iodophilic cytoplasmic structures (glycogen?), and the development of the specialty of Radiology. The author seems to have been completely unaffected by Dr. Kildare when he makes statements like: "Yet, instead of chiropractic, homeopathy, or any of the several other sects that we could have wound up with, allopathy, for better or for worse, has become the dominant medical sect in the United States."