Lorenz Heister and the challenge of trepanation: a neurosurgical case study from the 18th century

In the 18th century, medical practice was essentially based on communication. Cranial trepanation, however, was usually performed on an unconscious person. Here the dialogue ceased. It was the only operation which had to be attempted without the positive consent of the patient. Thus trepanation challenged the surgeon's skill not only with its intricate surgical practice, but also with its unusual social setting. The present paper illustrates possible ways out of the "trap of trepanation" by interweaving two points of view. On the one hand, a general account is given on the basis of surgical publications written by Lorenz Heister and his contemporaries. On the other, the unpublished sources of the Heister correspondence serve to reconstruct the case of Heinrich Wilhelm Bachmann, a German merchant who fell victim to a traffic accident and underwent trepanation in 1753. The case study shows how the physician in charge counterbalanced the patient's inability to communicate by strengthening the remaining network of professionals, and ultimately confirming his decisions by use of the post-mortem.     

Linking Up to Development? Global Value Chains and the Making of a Post‐Washington Consensus

Over the last decade, the global value chain (GVC) approach, with its associated notions of chain governance and firm upgrading, has proliferated as a mode of analysis and of intervention amongst development institutions. This article examines the adoption and adaptation of GVCs at four multilateral agencies in order to understand the purchase of value chain approaches within the development field. Mixing GVC perspectives with other theoretical influences and applied practices, these institutions deploy value chain frameworks to signal a new generation of policies that promise both to consolidate, and to advance beyond, the market fundamentalism of the Washington Consensus. To achieve this, value chain development frameworks craft interventions directed toward various constellations of firm and non‐firm actors as a ‘third way’ between state‐minimalist and state‐coordinated approaches. The authors identify key adaptations of the GVC framework including an emphasis on value chain governance as an instrument to correct market failure in partnership with state and development agencies, and upgrading as a de facto tool for poverty reduction. They find that efforts are ongoing to construct a ‘post’ to the Washington Consensus and that the global value chain is enabling this process by providing a new language and new object of development intervention: ‘the chain’ and the local–global linkages that comprise it.     

A Post-Roman Sequence at Carlisle Cathedral

Excavations in 1988 revealed a stratigraphic sequence extending from the later Roman period to the twelfth century. Of particular interest and importance is a collection of Viking-Age metalwork which, with other material, sheds light on settlement in Carlisle before the arrival of the Normans in 1092.