Atul Gawande: How Do Good Ideas Spread? : The New Yorker - 36 views
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Why do some innovations spread so swiftly and others so slowly
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Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century.
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The first public demonstration of anesthesia was in 1846.
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nsisted that he had found a gas that could render patients insensible to the pain of surgery.
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The idea spread like a contagion, travelling through letters, meetings, and periodicals. By mid-December, surgeons were administering ether to patients in Paris and London. By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world.
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On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw.
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Four weeks later, on November 18th, Bigelow published his report on the discovery of “insensibility produced by inhalation” in the Boston Medical and Surgical Journal.
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There were forces of resistance, to be sure. Some people criticized anesthesia as a “needless luxury”; clergymen deplored its use to reduce pain during childbirth as a frustration of the Almighty’s designs.
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Yet soon even the obstructors, “with a run, mounted behind—hurrahing and shouting with the best.” Within seven years, virtually every hospital in America and Britain had adopted the new discovery.
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Sepsis—infection—was the other great scourge of surgery. It was the single biggest killer of surgical patients, claiming as many as half of those who underwent major operations
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nfection was so prevalent that suppuration—the discharge of pus from a surgical wound—was thought to be a necessary part of healing.
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In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms. Lister became convinced that the same process accounted for wound sepsis.
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Lister had read about the city of Carlisle’s success in using a small amount of carbolic acid to eliminate the odor of sewage, and reasoned that it was destroying germs. Maybe it could do the same in surgery.
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During the next few years, he perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field.
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The result was strikingly lower rates of sepsis and death.
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Far from it.
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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.
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hey reused sea sponges without sterilizing them.
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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.
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Maybe ideas that violate prior beliefs are harder to embrace. To nineteenth-century surgeons, germ theory seemed as illogica
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The technical complexity might have been part of the difficulty. Giving Lister’s methods “a try” required painstaking attention to detail.
