The Spread Of Innovation

The Spread Of Innovation

Why do some innovations spread so quickly and others so slowly?

Article by : Biranchi, biology  is never just animals and plants and diseases, there is much more to it, there is technology, innovations and a lot more. Tried to pen down just one of its innumerable areas.

Consider the wide variety of surgical anesthesia and disinfection methods discovered in the 19th century. The first public demonstration of anesthesia was made in 1846. Boston surgeon Henry Jacob Bigelow approached a local dentist named William Morton, who claimed to have discovered a gas that could numb patients to surgical pain. It was a dramatic statement.

At that time, even a small extraction was painful. Without effective pain relief, surgeons have learned to work at an alarming rate. Caregivers pinned patients to the ground until they passed out in agony, screaming and writhing. Made a huge difference without trying anything. Bigelow nonetheless agreed to allow Morton to substantiate his statement.

Boston surgeon Henry Jacob Bigelow 

On October 16, 1846, at Massachusetts General Hospital, Morton gassed the mouth of a young man who had a tumor removed from his jaw via an inhaler. The patient was semi-conscious during the procedure and muttered under his breath. The next day, the woman who was undergoing surgery to remove a large tumor in her shoulder became completely silent and unable to move because of her gas. When she woke up, she said she felt nothing.

Four weeks later, on November 18, Bigelow published a report in the Boston Journal of Medicine and Surgery on his findings of “suction-induced numbness.”

Morton did not disclose the composition of the gas he named Leteon because he applied for a patent. But Bigelow reported that it smelled of ether (ether is used as an ingredient in some medicines), and that seemed to be enough. Ideas spread like a plague through letters, meetings and periodicals. By mid-December, surgeons were injecting ether into patients in Paris and London. Anesthesia was used in almost all European capitals in February and in most parts of the world in June.

Of course, there were resistance groups. Some have criticized anesthesia as an "unnecessary luxury". The clergy deplored its use to relieve pain during childbirth as a violation of the plan of the Almighty. James Miller, a 19th-century Scottish surgeon who chronicled the advent of anesthesia, observed the opposition of older surgeons: “They covered their ears, closed their eyes, and crossed their arms. . ..  They have firmly decided that suffering is a necessary evil and must be endured.” But soon even the obstacles "shuffled behind them, swearing and shouting with the best." Within seven years, nearly every hospital in the US and UK had accepted a new opening.

Sepsis (infection) was another major scourge of surgery.

It was the biggest cause of death for surgery patients, accounting for about half of patients with major surgeries such as open fracture treatment or limb amputation. Infections were so common that suppuration (the drainage of pus from surgical wounds) was considered a necessary part of healing.

In the 1860s Edinburgh surgeon Joseph Lister read an article by Louis Pasteur summarizing his evidence that putrefaction and fermentation are the result of microbes. Lister concluded that the same process causes wound sepsis. In addition to filtration and heating, Pasteur noticed that exposure to certain chemicals can destroy microorganisms.

Lister read an article about the city of Carlisle's success in removing sewer odors using small amounts of phenolic acid, and concluded that it killed germs. Perhaps you can do the same with surgery.

In the years that followed, he perfected a method of using phenolic acid to clean his hands and wounds and kill any germs that might have entered the surgical site. As a result, sepsis and mortality rates were remarkably low. You would think that when he published his observations in a series of pioneering reports in The Lancet in 1867, his method of disinfection spread as quickly as anesthesia.

Never. Surgeon J. M. T. Finney recalled that his hand washing was still sloppy when he interned at Massachusetts General Hospital 20 years later.

Surgeons soaked their instruments in carbolic acid, but they continued to operate in black frock coats stiffened with the blood and viscera of previous operations—the badge of a busy practice. Instead of using fresh gauze as sponges, they reused sea sponges without sterilizing them. It was a generation before Lister’s recommendations became routine and the next steps were taken toward the modern standard of asepsis—that is, entirely excluding germs from the surgical field, using heat-sterilized instruments and surgical teams clad in sterile gowns and gloves.

In our era of electronic communications, we’ve come to expect that important innovations will spread quickly. Plenty do: think of in-vitro fertilization, genomics, and communications technologies themselves.

But the list of important innovations that haven't caught on is equally long. The mystery is why.

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