“The Uncertain Method of Drops”: How a Non-uniform Unit Survived the Century of Standardization

This paper follows the journey of two small fluid units throughout the 19th century in Anglo-American medicine and pharmacy, explaining how the non-uniform “drop” survived while the standardized minim became obsolete. I emphasize two roles these units needed to fulfill: that of a physical measuring device, and that of a rhetorical communication device. First, I discuss the challenges unique to measuring small amounts of fluid, outlining how the modern medicine dropper developed out of an effort to resolve problems with the “minimometer,” which measured minim. Second, I explain how drops, utilized in “the open drop method” of administering general anesthesia, effectively communicated a gradual process and epistemically valuable heuristic to the audience of practitioners, whose attention to individual medical outcomes was important for verifying the proper dosage. The standardized minim was never able to achieve success as the drop’s intended replacement; the non-uniform drop better served the relevant epistemic goals within the practical contexts for which these units were designed. The surprising historical trajectory of drops should cause us to question the common equivocation of “standardization” with “progress” in the history and philosophy of measurement. This study also exemplifies how examining non-standard measurement practices can be instructive for better understanding the role and function of standardization within epistemology of measurement

The ups and downs of open innovation efficiency: the case of Procter & Gamble

Purpose Open innovation (OI) has become increasingly popular as an enterprise strategy in both industry and academia, and has been adopted, at least in part, by many companies. Despite this popularity, there is a dearth of evaluation of OI efficiency and a lack of suitable quantitative indices. The paper aims to discuss these issues. Design/methodology/approach In this study, the authors used both data envelopment analysis (DEA) and Malmquist techniques to compare the pre- and post-transition levels of performance achievement of Procter & Gamble (P&G), a widely recognised and public early adopter of OI, with a group of its main competitors. Findings Most detailed analysis of the time-course revealed that the innovation efficiency of P&G improved rapidly and substantially after its embracing of OI, an effect we term the “open rise”. However, there is also a transient decline in R&D efficiency at the beginning of OI adoption (“open dip”) and an unexpected and marked decline (“open drop”) after the peak positive effect. Originality/value The quantitative methods appear to meet the needs identified in the preceding literature for more quantitative approaches to the measurement of OI.

Of Penguins, Pinnipeds, and Poisons

Although Ernest Shackleton’s Endurance Antarctic expedition of 1914 to 1916 is a famous epic of survival, the medical achievements of the two expedition doctors have received little formal examination. Marooned on Elephant Island after the expedition ship sank, Drs. Macklin and McIlroy administered a chloroform anesthetic to crew member Perce Blackborow to amputate his frostbitten toes. As the saturated vapor pressure of chloroform at 0°C is 71.5 mmHg and the minimum alveolar concentration is 0.5% of sea-level atmospheric pressure (3.8 mmHg), it would have been feasible to induce anesthesia at a low temperature. However, given the potentially lethal hazards of a light chloroform anesthetic, an adequate and constant depth of anesthesia was essential. The pharmacokinetics of the volatile anesthetic, administered via the open-drop technique in the frigid environment, would have been unfamiliar to the occasional anesthetist. To facilitate vaporization of the chloroform, the team burned penguin skins and seal blubber under overturned lifeboats to increase the ambient temperature from −0.5° to 26.6°C. Chloroform degrades with heat to chlorine and phosgene, but buildup of these poisonous gases did not occur due to venting of the confined space by the stove chimney. The anesthetic went well, and the patient—and all the ship’s crew—survived to return home.

In praise of anesthesia: Two case studies of pain and suffering during major surgical procedures with and without anesthesia in the United States Civil War-1861–65

BackgroundThe United States Civil War (1861–1865) pitted the more populous industrialized North (Union) against the mainly agricultural slaveholding South (Confederacy). This conflict cost an enormous number of lives, with recent estimates mentioning a total mortality greater than 700,000 combatants [1]. Although sulfuric ether (ETH) and chloroform (CHL) were available since Morton’s use of the former in 1846 and the employment of the latter in 1847, and even though inhalational agents were used in Crimean war (1853–1856) and the Mexican-American War (1846–1848), the United States Civil War gave military surgeons on both sides the opportunity to experience the use of these two agents because of the large number of casualties.MethodsResearch of historic archives illustrates the dramatic control of surgical pain made possible with introduction of two general anesthetic and analgesic drugs in 1846 and 1847.ResultsAn appreciation of the importance of anesthesia during surgical procedures can be noted in the poignant and at times hair raising cases of two left arm amputations carried out under appalling circumstances during the United States Civil War. In the first-case the amputation was delayed for nearly five days after the wounding of Private Winchell who served in an elite sharpshooter brigade and was captured by the Confederate Army during battle. The amputation was performed without anesthesia and the voice of the Private himself narrates his dreadful experience. The postoperative course was incredible as he received no analgesia and survived a delirious comatose state lying on the ground in the intense summer heat.Thomas Jonathan “Stonewall” Jackson was a famous ascetic Confederate General who helped defeat the Union forces at the Battle of Chancellorsville on May 2, 1863. In the ensuing near-darkness, Jackson was fired upon by his own friendly troops where he suffered multiple gunshot wounds on his right hand as well as a ball in the upper humerus of the left arm similar to that of Private Winchell. Transported to a field hospital about thirty miles away, the evacuation was carried out under artillery fire and the General dropped from the stretcher at least twice before arriving at the field hospital. There, a team of surgeons operated on “Stonewall”, using open drop chloroform, the surgery taking 50 min, anesthesia times of one hour with General Jackson awake and speaking with clarity shortly after the termination of the anesthesia. A brief explanation of the use of anesthetics in the military environment during the Crimean, Mexican American and the United States Civil War is also presented.Conclusion and implicationsTwo case stories illustrate the profound improvement in surgical pain made possible with ether and chloroform only 160 years ago. Surgeons and patients nowadays have no ideas what these most important improvements in modern medicine means, unless “reliving” the true hell of pain surgery was before ether and chloroform.