To those who work in museums it is apparent
how new ideas and technologies grow out of earlier questions and
solutions to problems. This is in fact an important rationale for
why we collect the past and recognise its relevance to present and
future generations. There is the need in all of us to understand
our position in this flow and development of ideas.
Nowhere is this more apparent than in a medical
history museum, where one is able to see the visual evidence of
a refinement of answers to what were felt to be the most pressing
questions in medicine at that particular time. For example, one
can look at the changes in materials and design in such diagnostic
equipment as the thermometer, stethoscope, sphygmomanometer, or
the pulse taking machine, that had been discovered earlier in
the l9th century, but had only gradually gained acceptance. Their
use underwent much discussion on the pages of medical journals,
and modifications and improvements were made, until the turn of
the century when their combined use contributed to the more accurate
and effective diagnosis of disease. This federation of ideas was
not unlike the combining of State strengths to form a Commonwealth
of Australia that was occurring around this same time.
As we are aware the artefact has an attraction
and power all of its own and has a personal and direct way of
communicating with us. We admire it for its age, and the fact
that it has witnessed and survived the years, the materials used,
the workmanship, and often the elegance of design that particularly
in the case of instruments combines form with functionality. But
on another level, our objects can be valued as containers of ideas.
With research into trade catalogues, published texts, or information
about use and provenance, they become much more powerful tools
and keys to understanding a particular period and the development
of ideas.
The current exhibition at the Medical Museum
titled The Rise of Technology, takes as a particular example
the stethoscope, with a display of these instruments lined up
in the one case. Among the monaurial type (similar to those still
used in obstetrics to listen to the foetal heartbeat), one can
see how the designers and manufacturers experimented with various
factors including the different density of wood, ebony, ivory,
and silver for the best conductivity of sound. The width and shape
of the chestpiece, and the length, portability and strength of
the instrument were important considerations throughout the l
9th century when the physician made home visits and carried his
instruments in his bag. The stethoscope did not bring immediate
benefit to the physician, on the contrary, he had to become familiar
with and differentiate between the large and bewildering variety
of sounds it transmitted. He had to make qualitative assessments,
and it took time and perseverance to acquire these skills. The
identification of this broad spectrum of sounds produced a complex
new terminology such as rales, Fremitis, cracked-pot sound, metallic
tinkling, cavernous and puerile breathing, veiled puff and bruit.
This terminology then had to be associated with specific structural
or organic changes in order for the sounds to be used as diagnostic
signs of specific diseases.
The assimilation of diagnostic technology
such as the stethoscope, thermometer, sphygmomanometer and sphygmograph
into medical practice was influenced by a shift in emphasis from
seeking the cause and process of disease (derived from some outward
signs, later linked to post mortem findings), to the signs and
symptoms of disease. Subjectively derived information (from the
patient themselves or gained intuitively through the observation
of similar cases), was increasingly distrusted in favour of the
objective measurements these instruments provided. The application
of technology seemed a more rational and scientific approach.
Medicine gradually developed its methodology into one dependent
on instruments to discover the source of illness and then to cure
it. On looking at these instruments in the exhibition one may
be stimulated to think what changes did this approach bring about
in the relationship between patient and doctor? Might not the
narrower specialist terminology associated with the use of the
instruments produce a barrier of communication any less than the
physical separation and distancing caused by the application of
them?
While the use of instruments were the means
to more accurate diagnosis, the standardisation of physiological
functions measured by them gave rise to definitions of what was
'normal' and 'abnormal' in organic function or human behaviour
patterns. The physical advantages of instruments in providing
the means to record and define human disease are nevertheless
accompanied by social and intellectual questions. Herein lies
the subversiveness of history, and the power of the museum. Most
of the relevant technological developments in medicine and their
social effects appear in early form during the 19th century, and
much of the 20th and the present century's technology are built
upon beginnings.
Anne Brothers
The Rise of Technology can be viewed on the 2nd floor of the Brownless
Biomedical Library, The University of Melbourne, until mid May.
Hours: Mon-Frid 9-6pm, on Wed till 9pm and Sat by arrangement.
Further details phone Ann Brothers on (03) 8344 57l9.