Reflections on a Medical Innovation: Transcutaneous Oxygen Monitoring in Neonatal Intensive Care VALERIE MIKE, ALFRED N. KRAUSS, AND GAIL S. ROSS The history of medical technologies is a subject that has not received much scholarly attention. This is both odd and a cause for concern since the development of sound public policy with regard to the adoption and cost of medical technology is one of the most pressing matters on the political agenda of several industrial nations. One of the few scholars who has attended to this complex subject, Joel Howell, has argued that there is a considerable gap betwixt cup and lip: Howell’s case study of the electrocardiogram suggests to him that there can be, and has been, a gap of several decades between the invention of a new medical technology and its diffusion into general medical practice.1 We believe, in part on the basis of the case study presented in this article, that, while Howell’s conclusion may be valid for the early decades of the 20th century, its validity does not extend very much beyond the 1940s. The case of transcutaneous oxygen (tcPO2) moni toring of premature infants indicates that, for a variety of reasons, physicians have been very quick to adopt new technologies as soon as they have become available. Indeed, physicians in this instance may have been too quick, rushing to positive judgment too hastilyignoring the lack of adequate relevant evidence—in their effort to stem the tide of what appeared to be a growing and devastating epidemic. The complex and fascinating story of neonatal transcutaDr . Mike is a member of the Department of Public Health and Dr. Krauss and Dr. Ross are members of the Department of Pediatrics at Cornell University Medical College. Research for this article was supported in part by funds from the National Science Foundation, the Office of Maternal and Child Health (Department of Health and Human Services), the Esther A. and Joseph Klingenstein Fund, and the New York Community Trust. 'J. D. Howell, “Cardiac Physiology and Clinical Medicine? Two Case Studies,” in Physiology in the American Context, 1850-1940, ed. G. L. Geison (Bethesda, Md., 1987), pp. 279-92.© 1993 by the Society for the History of Technology. All rights reserved. 0040-165X/93/3404-0007$01.00 894 895 Transcutaneous Oxygen Monitoring in Neonatal Intensive Care neous oxygen monitoring suggests that it may be wise for both physicians and patients (in this case, the parents of patients) to learn to live with more uncertainty than they used to find comforting. The Clinical Setting Oxygen is essential for the survival and proper functioning of living tissue. A deficiency of oxygen can lead to death or serious illness, and in newborn infants it has been associated with poor neurological outcome in later life, such as mental retardation or cerebral palsy. Oxygen lack is observed by the clinician as cyanosis, a bluish discoloration of the skin and mucous membranes. The ability to diagnose the cause of oxygen deficiency and prescribe effective therapy clearly depends on the ability to recognize its presence and measure its severity. As oxygen therapy for newborn infants became available during the 1930s, the treatment was administered empirically. Oxygen was commonly prescribed “to prevent cyanosis,” as determined by visual observation of the patient. While orders of this type provided sufficient oxygen to relieve cyanosis in severely ill infants, no thought was initially given to the possibility that harm could occur because of too much oxygen. The administration of oxygen to distressed infants, first via incubators and later by means of mechanically assisted ventilation, improved the survival rate of critically ill newborns.2 Then, in 1941, a Boston pediatrician observed the presence of a new disease in the eyes of premature infants. Because of its appearance and location—scar tissue behind the lens of the eye—the disease was termed “retrolental fibroplasia” (RLF); in its most severe form RLF resulted in detachment ofthe retina and blindness. An example of the development of RLF is given in figure 1, showing the appearance of the retina through a direct ophthalmoscope on examination ofa prematurely born infant. Usually both eyes of the infant were affected. The early history of RLF has...