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Library of Congress Cataloging-in-Publication Data

Laudon, Kenneth C., 1944- author.

Essentials of management information systems / Kenneth C. Laudon, New York University, Jane P. Laudon,
Azimuth Information Systems.—Twelveth edition.
pages cm
Includes bibliographical references and index.
ISBN 978-0-13-423824-1—ISBN 0-13-423824-9
1. Management information systems. I. Laudon, Jane P. (Jane Price), author. II. Title.
T58.6.L3753 2017
658.4'038011—dc23
2015027175

10 9 8 7 6 5 4 3 2 1

ISBN 10: 0-13-423824-9

ISBN 13: 978-0-13-423824-1
About the Authors

Kenneth C. Laudon is a Professor of Information Systems at New York

University’s Stern School of Business. He holds a B.A. in Economics from Stanford and
a Ph.D. from Columbia University. He has authored twelve books dealing with elec-
tronic commerce, information systems, organizations, and society. Professor Laudon
has also written over forty articles concerned with the social, organizational, and man-
agement impacts of information systems, privacy, ethics, and multimedia technology.
Professor Laudon’s current research is on the planning and management of large-
scale information systems and multimedia information technology. He has received
grants from the National Science Foundation to study the evolution of national informa-
tion systems at the Social Security Administration, the IRS, and the FBI. Ken’s research
focuses on enterprise system implementation, computer-related organizational and
occupational changes in large organizations, changes in management ideology, changes
in public policy, and understanding productivity change in the knowledge sector.
Ken Laudon has testified as an expert before the United States Congress. He
has been a researcher and consultant to the Office of Technology Assessment
(United States Congress), Department of Homeland Security, and to the Office of
the President, several executive branch agencies, and Congressional Committees.
Professor Laudon also acts as an in-house educator for several consulting firms and
as a consultant on systems planning and strategy to several Fortune 500 firms.
At NYU’s Stern School of Business, Ken Laudon teaches courses on Managing
the Digital Firm, Information Technology and Corporate Strategy, Professional
Responsibility (Ethics), and Electronic Commerce and Digital Markets. Ken Laudon’s
hobby is sailing.

Jane Price Laudon is a management consultant in the information systems

area and the author of seven books. Her special interests include systems analysis,
data management, MIS auditing, software evaluation, and teaching business profes-
sionals how to design and use information systems.
Jane received her Ph.D. from Columbia University, her M.A. from Harvard
University, and her B.A. from Barnard College. She has taught at Columbia University
and the New York University Stern School of Business. She maintains a lifelong inter-
est in Oriental languages and civilizations.
The Laudons have two daughters, Erica and Elisabeth, to whom this book is dedicated.
vii
Brief Contents
Preface xvi

I Information Systems in the Digital Age 1

1 Business Information Systems in Your Career 2
2 Global E-Business and Collaboration 38
3 Achieving Competitive Advantage with Information Systems 76
4 Ethical and Social Issues in Information Systems 110

II Information Technology Infrastructure 149

5 IT Infrastructure: Hardware and Software 150
6 Foundations of Business Intelligence: Databases and Information Management 190
7 Telecommunications, the Internet, and Wireless Technology 226
8 Securing Information Systems 268

III Key System Applications for the Digital Age 307

9 Achieving Operational Excellence and Customer Intimacy: Enterprise Applications 308
10 E-Commerce: Digital Markets, Digital Goods 340
11 Improving Decision Making and Managing Knowledge 382

IV Building and Managing Systems 421

12 Building Information Systems and Managing Projects 422

Glossary 462
Index 479

viii
Complete Contents
Preface xvi
I Information Systems in the
Digital Age 1
1 Business Information Systems in Your Career 2
Chapter-Opening Case:
The San Francisco Giants Keep Winning
with Information Technology 3
1-1 Why are information systems so essential for
running and managing a business today? 5
How Information Systems Are Transforming Business 5 •
What’s New in Management Information Systems? 6 •
Globalization Challenges and Opportunities: A Flattened
World 8
Interactive Session: People
The Mobile Pocket Office 9
Business Drivers of Information Systems 11
1-2 What exactly is an information system? How
does it work? What are its people, organizational,
and technology components? 13
What Is an Information System? 13 • It Isn’t Simply
Technology: The Role of People and Organizations 15 •
Dimensions of Information Systems 16
Interactive Session: Technology
UPS Competes Globally with Information
Technology 19
1-3 How will a four-step method for business
problem solving help you solve information
system–related problems? 21
The Problem-Solving Approach 21 • A Model of the
Problem-Solving Process 21 • The Role of Critical
Thinking in Problem Solving 24 • The Connections
Among Business Objectives, Problems, and Solutions 24
1-4 How will information systems affect business
careers, and what information systems skills
and knowledge are essential? 25
How Information Systems Will Affect Business Careers 25
• Information Systems and Your Career: Wrap-Up 28
• How This Book Prepares You For the Future 29
Review Summary 30 •
Key Terms 30 • Review
Questions 31 • Discussion
Questions 31 • Hands-On
MIS Projects 32
Management Decision Problems
32 • Improving Decision Making:
Using Databases to Analyze Sales Trends 32 • Improving
Decision Making: Using the Internet to Locate Jobs
Requiring Information Systems Knowledge 33
Collaboration and Teamwork Project 33
Business Problem-Solving Case
Home Depot Renovates Itself with New Systems
and Ways of Working 34
2 Global E-Business and Collaboration 38
Chapter-Opening Case:
Enterprise Social Networking Helps ABB Innovate
and Grow 39
2-1 What major features of a business are
important for understanding the role
of information systems? 41
Organizing a Business: Basic Business Functions 41 •
Business Processes 42 • Managing a Business and
Firm Hierarchies 44 • The Business Environment 45 •
The Role of Information Systems in a Business 46
2-2 How do systems serve different management
groups in a business and how do systems that
link the enterprise improve organizational
performance? 46
Systems for Different Management Groups 47 •
Systems for Linking the Enterprise 51
Interactive Session: Organizations
New Systems Help Plan International Manage
Its Human Resources 52
E-Business, E-Commerce, and E-Government 55
2-3 Why are systems for collaboration and social
business so important and what technologies
do they use? 56
What Is Collaboration? 56 • What Is Social
Business? 57 • Business Benefits of Collaboration and
Social Business 58 • Building a Collaborative Culture
and Business Processes 60 • Tools and Technologies
for Collaboration and Social Business 60
Interactive Session: People
Is Social Business Working Out? 64
2-4 What is the role of the information systems
function in a business? 66
The Information Systems
Department 66 • Information
Systems Services 67
Review Summary 68 •
Key Terms 69 • Review
Questions 69 • Discussion
Questions 70 • Hands-On
MIS Projects 70
ix
 Management Decision Problems 70 • Improving Decision
Making: Using a Spreadsheet to Select Suppliers 71
• Achieving Operational Excellence: Using Internet
Software to Plan Efficient Transportation Routes 71
Collaboration and Teamwork Project 71
Business Problem-Solving Case
How Much Does Data-Driven Planting Help
Farmers? 72
3 Achieving Competitive Advantage with
Information Systems 76
Chapter-Opening Case:
Should T.J. Maxx Sell Online? 77
3-1 How do Porter’s competitive forces model, the
value chain model, synergies, core competencies,
and network-based strategies help companies
use information systems for competitive
advantage? 79
Porter’s Competitive Forces Model 79 • Information
System Strategies for Dealing with Competitive Forces 81
Interactive Session: Technology
Nike Becomes a Technology Company 83
The Internet’s Impact on Competitive Advantage 86 •
The Business Value Chain Model 87 • Synergies, Core
Competencies, and Network-Based Strategies 89 •
Disruptive Technologies: Riding the Wave 91
3-2 How do information systems help businesses
compete globally? 92
The Internet and Globalization 93 • Global Business and
System Strategies 93 • Global System Configuration 94
3-3 How do information systems help businesses
compete using quality and design? 95
What Is Quality? 95 • How Information Systems
Improve Quality 96
3-4 What is the role of business process management
(BPM) in enhancing competitiveness? 97
What is Business Process Management? 98
Interactive Session: Organizations
Datacard Group Redesigns the Way
It Works 100
Review Summary 102 •
Key Terms 103 • Review
Questions 103 • Discussion
Questions 104 • Hands-On
MIS Projects 104
Management Decision
Problems 104 • Improving
Decision Making: Using a Database to Clarify
Business Strategy 105 • Improving Decision
Making: Using Web Tools to Configure and
Price an Automobile 105
x
Collaboration and Teamwork Project 105
Business Problem-Solving Case
Will Technology Save Sears? 106
4 Ethical and Social Issues in Information
Systems 110
Chapter-Opening Case:
The Dark Side of Big Data 111
4-1 What ethical, social, and political issues are
raised by information systems? 113
A Model for Thinking About Ethical, Social, and
Political Issues 114 • Five Moral Dimensions of
the Information Age 115 • Key Technology Trends
That Raise Ethical Issues 116
4-2 What specific principles for conduct can
be used to guide ethical decisions? 118
Basic Concepts: Responsibility, Accountability,
and Liability 118
Interactive Session: Organizations
Edward Snowden: Traitor or Protector
of Privacy? 119
Ethical Analysis 120 • Candidate Ethical Principles 121 •
Professional Codes of Conduct 122 • Some Real-World
Ethical Dilemmas 122
4-3 Why do contemporary information systems
technology and the Internet pose challenges
to the protection of individual privacy and
intellectual property? 122
Information Rights: Privacy and Freedom in the Internet
Age 122 • Property Rights: Intellectual Property 129
4-4 How have information systems affected laws
for establishing accountability and liability
and the quality of everyday life? 132
Computer-Related Liability Problems 132 • System
Quality: Data Quality and System Errors 133 • Quality
of Life: Equity, Access, and Boundaries 134 • Health
Risks: RSI, CVS, and Cognitive Decline 137
Interactive Session: People
Are We Relying Too Much on Computers
to Think for Us? 138
Review Summary 140 •
Key Terms 141 • Review
Questions 141 • Discussion
Questions 142 • Hands-On
MIS Projects 142
Management Decision
Problems 142 • Achieving
Operational Excellence:
Creating a Simple Blog 143 • Improving
Decision Making: Analyzing Web Browser
Privacy 143
Collaboration and Teamwork Project 143
Business Problem-Solving Case
Facebook Privacy: What Privacy? 144
II Information Technology
Infrastructure 149
5 IT Infrastructure: Hardware and Software 150
Chapter-Opening Case:
EasyJet Flies High with Cloud Computing 151
5-1 What are the components of
IT infrastructure? 153
Infrastructure Components 153
5-2 What are the major computer hardware,
data storage, input, and output technologies
used in business and the major hardware
trends? 155
Types of Computers 155 • Storage, Input,
and Output Technology 157 • Contemporary
Hardware Trends 158
Interactive Session: Technology
Wearable Computers Go to Work 160
Interactive Session: Organizations
Cloud Computing Takes Off 165
5-3 What are the major types of computer software
used in business and the major software
trends? 169
Operating System Software 169 • Application
Software and Desktop Productivity Tools 171 •
HTML and HTML5 173 • Web Services 174 •
Software Trends 175
5-4 What are the principal issues in managing
hardware and software technology? 177
Capacity Planning and Scalability 177 • Total Cost
of Ownership (TCO) of Technology Assets 177 • Using
Technology Service Providers 178 • Managing Mobile
Platforms 179 • Managing Software Localization for
Global Business 180
Review Summary 180 •
Key Terms 182 • Review
Questions 182 • Discussion
Questions 183 • Hands-On
MIS Projects 183
Management Decision
Problems 183 • Improving
Decision Making: Using a Spreadsheet to Evaluate
Hardware and Software Options 184 • Improving
Decision Making: Using Web Research to Budget
for a Sales Conference 184
Collaboration and Teamwork Project 185
Business Problem-Solving Case
BYOD: Business Opportunity
or Big Headache? 186
6 Foundations of Business Intelligence: Databases
and Information Management 190
Chapter-Opening Case:
Better Data Management Helps the US Postal
Service Rebound 191
6-1 What is a database and how does a relational
database organize data? 193
Entities and Attributes 194 • Organizing Data in
a Relational Database 194 • Establishing
Relationships 196
6-2 What are the principles of a database
management system? 199
Operations of a Relational DBMS 200 • Capabilities
of Database Management Systems 202 • Nonrelational
Databases and Databases in the Cloud 203
6-3 What are the principal tools and technologies
for accessing information from databases to
improve business performance and decision
making? 204
The Challenge of Big Data 204 • Business Intelligence
Infrastructure 205
Interactive Session: People
New York City Embraces Data-Driven Crime
Fighting 206
Interactive Session: Technology
Driving ARI Fleet Management with Real-Time
Analytics 209
Analytical Tools: Relationships, Patterns, Trends 210 •
Databases and the Web 214
6-4 Why are information policy, data administration,
and data quality assurance essential for
managing the firm’s data resources? 215
Establishing an Information Policy 215 • Ensuring
Data Quality 215
Review Summary 216 •
Key Terms 217 • Review
Questions 218 • Discussion
Questions 219 • Hands-On
MIS Projects 219
Management Decision
Problems 219 • Achieving
Operational Excellence: Building a Relational
Database for Inventory Management 220 • Improving
Decision Making: Searching Online Databases For
Overseas Business Resources 220
Collaboration and Teamwork Project 221
xi
Business Problem-Solving Case
Can We Trust Big Data? 222 8 Securing Information Systems 268
Chapter-Opening Case:
7 Telecommunications, the Internet, and Wireless Target Becomes the Target for Massive Data
Technology 226 Theft 269
Chapter-Opening Case: 8-1 Why are information systems vulnerable
Wireless Technology Makes Dundee Precious Metals to destruction, error, and abuse? 271
Good as Gold 227 Why Systems Are Vulnerable 271 • Malicious
7-1 What are the principal components Software: Viruses, Worms, Trojan Horses, and
of telecommunications networks and key Spyware 274 • Hackers and Computer Crime 276 •
networking technologies? 229 Internal Threats: Employees 280 • Software
Networking and Communication Trends 229 • What Vulnerability 280
is a Computer Network? 230 • Key Digital Networking 8-2 What is the business value of security and
Technologies 231 control? 281
7-2 What are the different types of Legal and Regulatory Requirements for Electronic
networks? 234 Records Management 282 • Electronic Evidence
Signals: Digital vs. Analog 234 • Types of and Computer Forensics 283
Networks 235 • Transmission Media and 8-3 What are the components of an organizational
Transmission Speed 236 framework for security and control? 283
7-3 How do the Internet and Internet technology Information Systems Controls 283 • Risk Assessment 284
work and how do they support communication Interactive Session: People
and e-business? 236 The Flash Crash: A New Culprit 285
What Is the Internet? 236 • Internet Addressing and
Architecture 237 Security Policy 287 • Disaster Recovery Planning
and Business Continuity Planning 288 • The Role
Interactive Session: Organizations of Auditing 289
The Battle over Net Neutrality 240 8-4 What are the most important tools and
Internet Services and Communication Tools 241
technologies for safeguarding information
Interactive Session: People resources? 289
Monitoring Employees on Networks: Unethical Identity Management and Authentication 290 •
or Good Business? 244 Firewalls, Intrusion Detection Systems, and Antivirus
The Web 246 Software 291 • Securing Wireless Networks 293 •
7-4 What are the principal technologies and standards Encryption and Public Key Infrastructure 293 •
for wireless networking, communication, and Ensuring System Availability 295 • Security Issues for
Internet access? 253 Cloud Computing and the Mobile Digital Platform 295 •
Cellular Systems 253 • Wireless Computer Networks Ensuring Software Quality 296
and Internet Access 254 • RFID and Wireless Sensor
Interactive Session: Technology
Networks 256
BYOD: A Security Nightmare? 297
Review Summary 259 •
Key Terms 260 • Review Review Summary 299 •
Questions 261 • Discussion Key Terms 300 • Review
Questions 261 • Hands-On Questions 300 • Discussion
MIS Projects 261 Questions 301 • Hands-On
MIS Projects 301
Management Decision
Problems 262 • Improving Management Decision
Decision Making: Using Spreadsheet Software to Problems 301 • Improving
Evaluate Wireless Services 262 • Achieving Operational Decision Making: Using Spreadsheet Software
Excellence: Using Web Search Engines for Business to Perform a Security Risk Assessment 302 •
Research 262 Improving Decision Making: Evaluating Security
Outsourcing Services 302
Collaboration and Teamwork Project 263
Collaboration and Teamwork Project 302
Business Problem-Solving Case
Google, Apple, and Facebook Struggle for Your Business Problem-Solving Case
Internet Experience 264 Sony Hacked Again: Bigger Than Ever 303
xii
III Key System Applications
for the Digital Age 307
9 Achieving Operational Excellence and Customer
Intimacy: Enterprise Applications 308
Chapter-Opening Case:
ACH Food Companies Transforms Its Business with
Enterprise Systems 309
9-1 How do enterprise systems help businesses
achieve operational excellence? 311
What are Enterprise Systems? 311 • Enterprise
Software 312 • Business Value of Enterprise
Systems 313
9-2 How do supply chain management systems
coordinate planning, production, and logistics
with suppliers? 314
The Supply Chain 314 • Information Systems and Supply
Chain Management 316 • Supply Chain Management
Software 317
Interactive Session: Organizations
Scotts Miracle-Gro Cultivates Supply Chain
Proficiency 319
Global Supply Chains and the Internet 320 • Business
Value of Supply Chain Management Systems 321
9-3 How do customer relationship management
systems help firms achieve customer
intimacy? 322
What Is Customer Relationship Management? 322 •
Customer Relationship Management Software 323 •
Operational and Analytical CRM 325 • Business
Value of Customer Relationship Management
Systems 327
9-4 What are the challenges that enterprise
applications pose and how are enterprise
applications taking advantage of new
technologies? 327
Enterprise Application Challenges 327 • Next-
Generation Enterprise Applications 328
Interactive Session: Technology
Unilever Unifies Globally with Enhanced ERP 330
Review Summary 331 •
Key Terms 332 • Review
Questions 333 • Discussion
Questions 333 • Hands-On
MIS Projects 334
Management Decision
Problems 334 • Improving
Decision Making: Using Database Software to
Manage Customer Service Requests 334 • Achieving
Operational Excellence: Evaluating Supply Chain
Management Services 335
Collaboration and Teamwork Project 335
Business Problem-Solving Case
Customer Relationship Management Helps Celcom
Become Number One 336
10 E-Commerce: Digital Markets, Digital
Goods 340
Chapter-Opening Case:
Uber Digitally Disrupts the Taxi
Industry 341
10-1 What are the unique features of e-commerce,
digital markets, and digital goods? 343
E-Commerce Today 344 • The New E-Commerce:
Social, Mobile, Local 345 • Why E-commerce
is Different 347 • Key Concepts in E-commerce:
Digital Markets and Digital Goods in a Global
Marketplace 349
10-2 What are the principal e-commerce business
and revenue models? 353
Types of E-Commerce 353 • E-Commerce Business
Models 353 • E-Commerce Revenue Models 356
10-3 How has e-commerce transformed
marketing? 358
Behavioral Targeting 358 • Social E-commerce
and Social Network Marketing 361
Interactive Session: People
Getting Social with Customers 364
10-4 How has e-commerce affected Business-
to-Business transactions? 365
Electronic Data Interchange (EDI) 366 • New Ways
of B2B Buying and Selling 366
10-5 What is the role of m-commerce in
business, and what are the most important
m-commerce applications? 368
Location-Based Services and Applications 369
Interactive Session: Organizations
Can Instacart Deliver? 370
Other Mobile Commerce Services 371
10-6 What issues must be addressed when building
an e-commerce presence? 372
Develop an E-commerce Presence Map 372 •
Develop a Timeline: Milestones 373
Review Summary 374 •
Key Terms 375 • Review
Questions 375 • Discussion
Questions 376 • Hands-On
MIS Projects 376
Management Decision
Problems 376 • Improving
Decision Making: Using Spreadsheet Software
to Analyze a Dot-Com Business 376 • Achieving
xiii
 Operational Excellence: Evaluating E-Commerce
Hosting Services 377
Collaboration and Teamwork Project 377
Business Problem-Solving Case
Walmart and Amazon Duke It Out for E-Commerce
Supremacy 378
11 Improving Decision Making and Managing
Knowledge 382
Chapter-Opening Case:
Germany Wins the World Cup with Big Data
at Its Side 383
11-1 What are the different types of decisions,
and how does the decision-making process
work? 385
Business Value of Improved Decision Making 385 •
Types of Decisions 386 • The Decision-Making
Process 387 • High-Velocity Automated Decision
Making 387 • Quality of Decisions and Decision
Making 388
11-2 How do business intelligence and business
analytics support decision making? 388
What is Business Intelligence? 389 • The Business
Intelligence Environment 389 • Business Intelligence
and Analytics Capabilities 390
Interactive Session: Technology
America’s Cup: The Tension Between Technology
and Human Decision Makers 394
Business Intelligence Users 396 • Group Decision-
Support Systems 399
11-3 What are the business benefits of using
intelligent techniques in decision making
and knowledge management? 400
Expert Systems 400 • Case-Based Reasoning 401 •
Fuzzy Logic Systems 402 • Neural Networks 403 •
Genetic Algorithms 404
Interactive Session: People
Facial Recognition Systems: Another Threat
to Privacy? 405
Intelligent Agents 407
11-4 What types of systems are used for enterprise-
wide knowledge management and knowledge
work, and how do they provide value for
businesses? 408
Enterprise-Wide Knowledge Management Systems 408 •
Knowledge Work Systems 410
Review Summary 412 •
Key Terms 414 • Review
Questions 414 • Discussion
Questions 415 • Hands-On
MIS Projects 415
xiv
Management Decision Problems 415 • Improving
Decision Making: Using Pivot Tables to Analyze
Sales Data 416 • Improving Decision Making: Using
Intelligent Agents for Comparison Shopping 416
Collaboration and Teamwork Project 416
Business Problem-Solving Case
What’s Up with IBM’s Watson? 416
IV Building and Managing
Systems 421
12 Building Information Systems and Managing
Projects 422
Chapter-Opening Case:
Girl Scout Cookie Sales Go Digital 423
12-1 What are the core problem-solving steps for
developing new information systems? 425
Defining and Understanding the Problem 425 • Developing
Alternative Solutions 427 • Evaluating and Choosing
Solutions 427 • Implementing the Solution 428
12-2 What are the alternative methods for building
information systems? 431
Traditional Systems Development Life Cycle 431 •
Prototyping 432 • End-User Development 433 •
Purchasing Solutions: Application Software
Packages and Outsourcing 433 • Mobile Application
Development: Designing for a Multi-Screen
World 435 • Rapid Application Development
for E-Business 436
Interactive Session: Technology
The Challenge of Mobile Application
Development 437
12-3 What are the principal methodologies for
modeling and designing systems? 438
Structured Methodologies 438 • Object-Oriented
Development 440 • Computer-Aided Software
Engineering (CASE) 442
12-4 How should
information systems
projects be selected
and managed? 442
Project Management
Objectives 442
Interactive Session: Organizations
Britain’s National Health Service Jettisons Choose
and Book System 443
Selecting Projects: Making the Business Case for
a New System 445 • Managing Project Risk and
System-Related Change 448
Review Summary 452 • Key Terms 454 • Review
Questions 454 • Discussion Questions 455 • Hands-On
MIS Projects 455
Management Decision Problems 455 • Improving
Decision Making: Using Database Software to
Design a Customer System for Auto Sales 456 •
Achieving Operational Excellence: Analyzing Web
Site Design and Information Requirements 456
Collaboration and Teamwork Project 456
Business Problem-Solving Case
A Shaky Start for Healthcare.gov 457
Glossary 462
Index 479

xv
 Preface

We wrote this book for business school students who wanted an in-depth look at how
today’s business firms use information technologies and systems to achieve corpo-
rate objectives. Information systems are one of the major tools available to business
managers for achieving operational excellence, developing new products and services,
improving decision making, and achieving competitive advantage. Students will find
here the most up-to-date and comprehensive overview of how business firms use
information systems to achieve these objectives. After reading this book, we expect
students will be able to participate in, and even lead, management discussions of
information systems for their firms.
When interviewing potential employees, business firms often look for new hires
who know how to use information systems and technologies for achieving bottom-line
business results. Regardless of whether you are an accounting, finance, management,
operations management, marketing, or information systems major, the knowledge and
information you find in this book will be valuable throughout your business career.

What’s New in This Edition

CuRRENCy
The 12th edition features all new opening, closing, and Interactive Session cases. The
text, figures, tables, and cases have been updated through September 2015 with the
latest sources from industry and MIS research.

NEW FEATuRES
• Assisted-graded Writing Questions at the end of each chapter with prebuilt grad-
ing rubrics and computerized essay scoring help instructors prepare, deliver, and
grade writing assignments.
• A new Video Cases collection contains 31 video cases (2 or more per chapter) and
13 additional instructional videos covering key concepts and experiences in the
MIS world.
• The text contains 47 Learning Tracks in MyMISLab for additional coverage of selected
topics.
• Video Cases and Chapter Cases are listed at the beginning of each chapter.

NEW TOPICS
• Big data and the Internet of Things: In-depth coverage of big data, big data ana-
lytics, and the Internet of Things (IoT) are included in Chapters 1, 6, 7, and 11.
Coverage includes big data analytics, analyzing IoT data streams, Hadoop,
in-memory computing, nonrelational databases, and analytic platforms.
• Cloud computing:Updated and expanded coverage of cloud computing appears in
Chapter 5 (IT Infrastructure) with more detail on types of cloud services, private
and public clouds, hybrid clouds, managing cloud services, and a new Interactive
Session on using cloud services. Cloud computing is also covered in Chapter 6 (data-
bases in the cloud), Chapter 8 (cloud security), Chapter 9 (cloud-based CRM and
ERP), Chapter 10 (e-commerce), and Chapter 12 (cloud-based systems development).
• Social, mobile, local: New e-commerce content in Chapter 10 describes how social
tools, mobile technology, and location-based services are transforming marketing
and advertising.
xvi
 • Social business: Expanded coverage of social business is introduced in Chapter 2
and discussed throughout the text. Detailed discussions of enterprise (internal cor-
porate) social networking as well as social networking in e-commerce are included.
• BYOD and mobile device management
• Wearable computers
• Smart products
• Internet of Things (IoT)
• Mobile application development, mobile and native apps
• Operational intelligence
• Expanded coverage of business analytics, including big data analytics
• On-demand business
• Windows 10
• Microsoft Office 365
• Zero-day vulnerabilities
• Two-factor authentication
• Ransomware
• Chief data officer
• MOOCs in business firms

What’s New in MIS?

Plenty. In fact, there’s a whole new world of doing business using new technologies for
managing and organizing. What makes the MIS field the most exciting area of study
in schools of business is the continuous change in technology, management, and busi-
ness processes. (Chapter 1 describes these changes in more detail.)

IT INNOVATIONS
A continuing stream of information technology innovations is transforming the tradi-
tional business world. Examples include the emergence of cloud computing, the growth
of a mobile digital business platform based on smartphones and tablet computers, big
data, and the use of social networks by managers to achieve business objectives. Most
of these changes have occurred in the past few years. These innovations enable entre-
preneurs and innovative traditional firms to create new products and services, develop
new business models, and transform the day-to-day conduct of business. In the process,
some old businesses, even industries, are being destroyed while new businesses are
springing up.

NEW BuSINESS MODELS

For instance, the emergence of online video services such as Netflix for streaming,
Apple iTunes, Amazon, and many others for downloading video, has forever changed
how premium video is distributed and even created. Netflix in 2015 attracted 62 million
subscribers worldwide to what it calls the Internet TV revolution. Netflix has moved into
premium TV show production with nearly 30 original shows such as House of Cards and
Orange is the New Black challenging cable and broadcast producers of TV shows and
potentially disrupting cable network dominance of TV show production. Apple’s iTunes
now accounts for 67 percent of movie and TV show downloads and has struck deals with
major Hollywood studios for recent movies and TV shows. A growing trickle of viewers
are unplugging from cable and using only the Internet for entertainment.

E-COMMERCE ExPANDINg
E-commerce generated about $531 billion in revenues in 2015 and is estimated to grow
to nearly $800 billion by 2019. E-commerce is changing how firms design, produce, and xvii
 deliver their products and services. E-commerce has reinvented itself again, disrupting
the traditional marketing and advertising industry and putting major media and con-
tent firms in jeopardy. Facebook and other social networking sites such as YouTube,
Twitter, and Tumblr, along with Netflix, Apple Beats music service, and many other
media firms exemplify the new face of e-commerce in the 21st century. They sell ser-
vices. When we think of e-commerce, we tend to think of selling physical products.
Although this iconic vision of e-commerce is still very powerful and the fastest growing
form of retail in the U.S., growing up alongside is a whole new value stream based on
selling services, not goods. It’s a services model of e-commerce. Growth in social com-
merce is spurred by powerful growth of the mobile platform; 80 percent of Facebook’s
users access the service from mobile phones and tablets. Information systems and
technologies are the foundation of this new services-based e-commerce.

MANAgEMENT CHANgES
Likewise, the management of business firms has changed: With new mobile smart-
phones, high-speed wireless Wi-Fi networks, and wireless laptop computers, remote
salespeople on the road are only seconds away from their managers’ questions and
oversight. Business is going mobile, along with consumers. Managers on the move
are in direct, continuous contact with their employees. The growth of enterprise-wide
information systems with extraordinarily rich data means that managers no longer
operate in a fog of confusion but, instead, have online, nearly instant access to the
really important information they need for accurate and timely decisions. In addition
to their public uses on the web, wikis and blogs are becoming important corporate
tools for communication, collaboration, and information sharing.

CHANgES IN FIRMS AND ORgANIzATIONS

Compared to industrial organizations of the previous century, new, fast-growing,
21st-century business firms put less emphasis on hierarchy and structure and more
emphasis on employees taking on multiple roles and tasks. They put greater emphasis
on competency and skills than on position in the hierarchy. They emphasize higher
speed and more accurate decision making based on data and analysis. They are more
aware of changes in technology, consumer attitudes, and culture. They use social
media to enter into conversations with consumers and demonstrate a greater willing-
ness to listen to consumers, in part because they have no choice. They show better
understanding of the importance of information technology in creating and man-
aging business firms and other organizations. To the extent that organizations and
business firms demonstrate these characteristics, they are 21st-century digital firms.

The 12th Edition: The Comprehensive Solution

for the MIS Curriculum
Since its inception, this text has helped define the MIS course around the globe. This
edition continues to be authoritative but is also more customizable, flexible, and
geared to meeting the needs of different colleges, universities, and individual instruc-
tors. Many of its learning tools are now available in digital form. This book is now
part of a complete learning package that includes the core text, Video Case Study
Package, and Learning Tracks.
The core text consists of 12 chapters with hands-on projects covering the most
essential topics in MIS. An important part of the core text is the Video Case Study
and Instructional Video Package: 31 video case studies (2 to 3 per chapter) plus 13
instructional videos that illustrate business uses of information systems, explain new
technologies, and explore concepts. Videos are keyed to the topics of each chapter.
xviii
 A diagram accompany-
ing each chapter-opening
Business
Challenges case graphically illustrates
how people, organization,
• Highly competitive sport and technology elements
• Monitor games
and ticket sales • Opportunities from new technology work together to create
People
• Revise business an information system
strategies solution to the business
challenges discussed
in the case.
• Redesign job Information Business
functions and Organization System Solutions
workflows

Ticketing systems • Increase revenue

• Optimize ticket sales
• Provide secondary ticket market
Performance analysis system
• Fieldf/x • Analyze player and team performance
• Qcue dynamic Technology Interactive Services
ticketing software
• Secondary
ticketing platform
• Wi-Fi network

In addition, for students and instructors who want to go deeper into selected
topics, 47 Learning Tracks in MyMISLab cover a variety of MIS topics in greater
depth.

THE CORE TExT

The core text provides an overview of fundamental MIS concepts by using an
integrated framework for describing and analyzing information systems. This frame-
work shows information systems composed of people, organization, and technology
elements and is reinforced in student projects and case studies.

CHAPTER ORgANIzATION
Each chapter contains the following elements:
• A Chapter Outline based on Learning Objectives
• Lists of all the Case Studies and Video Cases for each chapter
• A chapter-opening case describing a real-world organization to establish the
theme and importance of the chapter
• A diagram analyzing the opening case in terms of the people, organization, and
technology model used throughout the text
• Two Interactive Sessions with Case Study Questions
• A Review Summary keyed to the Student Learning Objectives
• A list of Key Terms that students can use to review concepts
• Review questions for students to test their comprehension of chapter material
• Discussion questions the broader themes of the chapter raise.
• A series of Hands-on MIS Projects consisting of two Management Decision
Problems, a hands-on application software project, and a project to develop
Internet skills
• A Collaboration and Teamwork Project to develop teamwork and presentation
skills, with options for using open source collaboration tools
• A chapter-ending case study for students to apply chapter concepts
• Two assisted-graded writing questions with prebuilt grading rubrics
• Chapter references
xix
 KEy FEATuRES
We have enhanced the text to make it more interactive, leading-edge, and appealing
to both students and instructors. The features and learning tools are described in the
following sections:

Business-Driven with Real-World Business Cases and Examples

The text helps students see the direct connection between information systems and
business performance. It describes the main business objectives driving the use of
information systems and technologies in corporations all over the world: operational
excellence, new products and services, customer and supplier intimacy, improved decision
making, competitive advantage, and survival. In-text examples and case studies show stu-
dents how specific companies use information systems to achieve these objectives.
We use only current (2015) examples from business and public organizations
throughout the text to illustrate the important concepts in each chapter. All the case
studies describe companies or organizations that are familiar to students, such as the
San Francisco Giants, Facebook, Walmart, Google, Target, and Home Depot.

Interactivity
There’s no better way to learn about MIS than by doing MIS! We provide different
kinds of hands-on projects by which students can work with real-world business sce-
narios and data and learn firsthand what MIS is all about. These projects heighten
student involvement in this exciting subject.
• Online Video Case Package: Students can watch short videos online, either in class
or at home or work, and then apply the concepts of the book to the analysis of the
video. Every chapter contains at least two business video cases that explain how
business firms and managers are using information systems and explore concepts
discussed in the chapter. Each video case consists of a video about a real-world
company, a background text case, and case study questions. These video cases
enhance students’ understanding of MIS topics and the relevance of MIS to the
business world. In addition, 13 Instructional Videos describe developments and
concepts in MIS keyed to respective chapters.
• Interactive Sessions: Two short cases in each chapter have been redesigned as
Interactive Sessions to be used in the classroom (or on Internet discussion boards)
to stimulate student interest and active learning. Each case concludes with case
study questions. The case study questions provide topics for class discussion,
Internet discussion, or written assignments.

INTERACTIVE SESSION: PEOPLE Getting Social with Customers

Each chapter contains
two Interactive Sessions
on People, Organiza-
tions, or Technology
using real-world
companies to illustrate
chapter concepts and
issues.
xx
Businesses of all sizes are finding Facebook,
Twitter, and other social media to be powerful tools
for engaging customers, amplifying product mes-
sages, discovering trends and influencers, building
brand awareness, and taking action on customer
requests and recommendations. Half of all Twitter
users recommend products in their tweets.
About 1.4 billion people use Facebook, and
more than 30 million businesses have active brand
pages enabling users to interact with the brand
through blogs, comment pages, contests, and offer-
ings on the brand page. The Like button gives
users a chance to share with their social network
their feelings about content and other objects they
are viewing and websites they are visiting. With
Like buttons on millions of websites, Facebook can
track user behavior on other sites and then sell this
information to marketers. Facebook also sells dis-
play ads to firms that show up in the right column
In addition to monitoring people’s chatter
on Twitter, Facebook, and other social media,
some companies are using sentiment analysis (see
Chapter 6) to probe more deeply into their likes
and dislikes. For example, during the 2014 Golden
Globe Awards, thousands of women watching
the ceremony tweeted detailed comments about
Hayden Panettiere and Kelly Osborne’s slicked-
back hairdos. Almost instantaneously, the Twitter
feeds of these women received instructions from
L’Oréal Paris showing them how to capture vari-
ous red-carpet looks at home, along with pro-
motions and special deals for L’Oréal products.
L’Oreal had worked with Poptip, a real-time mar-
ket research company to analyze what conversa-
tions about hairstyling connected to Golden Globe
hashtags and other key phrases were appearing
on Twitter. When the Golden Globe red-carpet
events began, Poptip’s software looked for similar
 CASE STUDY QUESTIONS
1. Assess the people, organization, and
technology issues for using social media to
engage with customers.
2. What are the advantages and disadvantages
of using social media for advertising, brand
building, market research, and customer
service?
Case Study Questions
encourage students to
3. Give some examples of business decisions in
this case study that were facilitated by using
apply chapter concepts
social media to interact with customers. to real-world compa-
nies in class discussions,
4. Should all companies use Facebook and
Twitter for customer service and marketing?
student presentations,
Why or why not? What kinds of companies are or writing assignments.
best suited to use these platforms?

• Hands-on MIS Projects: Every chapter concludes with a Hands-on MIS Projects
section containing three types of projects: two Management Decision problems;
a hands-on application software exercise using Microsoft Excel, Access, or web
page and blog creation tools; and a project that develops Internet business skills.
A Dirt Bikes USA running case in MyMISLab provides additional hands-on
projects for each chapter.

11-9 Applebee’s is the largest casual dining chain in the world, with more than 1800 lo-
cations throughout the United States and 20 other countries. The menu features Two real-world business
beef, chicken, and pork items as well as burgers, pasta, and seafood. Applebee’s scenarios per chapter
CEO wants to make the restaurant more profitable by developing menus that provide opportunities
are tastier and contain more items that customers want and are willing to pay for students to apply
for despite rising costs for gasoline and agricultural products. How might busi- chapter concepts and
ness intelligence help management implement this strategy? What pieces of data practice management
would Applebee’s need to collect? What kinds of reports would be useful to help decision making.
management make decisions about how to improve menus and profitability?

Students practice using

software in real-world
settings for achieving
operational excellence
and enhancing decision
making.

xxi

Each chapter features
a project to develop
Internet skills for
accessing information,
conducting research,
and performing online
calculations and analysis.
IMPROVING DECISION MAKING: USING WEB TOOLS TO CONFIGURE
AND PRICE AN AUTOMOBILE
Software skills: Internet-based software
Business skills: Researching product information and pricing
3-11 In this exercise, you will use software at car-selling websites to find product infor-
mation about a car of your choice and use that information to make an important
purchase decision. You will also evaluate two of these sites as selling tools.
You are interested in purchasing a new Ford Escape (or some other car of your
choice). Go to the website of CarsDirect (www.carsdirect.com) and begin your inves-
tigation. Locate the Ford Escape. Research the various Escape models; choose one
you prefer in terms of price, features, and safety ratings. Locate and read at least
two reviews. Surf the website of the manufacturer, in this case Ford (www.ford.com).
Compare the information available on Ford’s website with that of CarsDirect for the
Ford Escape. Try to locate the lowest price for the car you want in a local dealer’s
inventory. Suggest improvements for CarsDirect.com and Ford.com.

• Collaboration and Teamwork Projects: Each chapter features a collaborative proj-

ect that encourages students working in teams to use Google Drive, Google Docs,
or other open-source collaboration tools. The first team project in Chapter 1 asks
students to build a collaborative Google site.

Assessment and AACSB Assessment Guidelines

The Association to Advance Collegiate Schools of Business (AACSB) is a not-for-profit
corporation of educational institutions, corporations and other organizations that seek
to improve business education primarily by accrediting university business programs. As
part of its accreditation activities, the AACSB has developed an Assurance of Learning
Program designed to ensure that schools do in fact teach students what they promise.
Schools are required to state a clear mission, develop a coherent business program, identify
student learning objectives, and then prove that students do in fact achieve the objectives.
We have attempted in this book to support AACSB efforts to encourage assess-
ment-based education. The front end papers of this edition identify student learning
objectives and anticipated outcomes for our Hands-on MIS projects. The authors will
provide custom advice on how to use this text in their colleges with different missions
and assessment needs. Please email the authors or contact your local Pearson repre-
sentative for contact information.
For more information on the AACSB Assurance of Learning Program, and how
this text supports assessment-based learning, please visit the website for this book.

Customization and Flexibility: New Learning Track Modules

Our Learning Tracks feature gives instructors the flexibility to provide in-depth cover-
age of the topics they choose. Forty-seven Learning Tracks in MyMISLab are available
to instructors and students. This supplementary content takes students deeper into
MIS topics, concepts, and debates; reviews basic technology concepts in hardware,
software, database design, telecommunications, and other areas; and provides addi-
tional hands-on software instruction. The 12th edition includes new Learning Tracks
on e-commerce payment systems, including Bitcoin, and Occupational and Career
Outlook for Information Systems Majors 2012–2020.

Author-certified test bank and supplements

• Author-certified test bank: The authors have worked closely with skilled test item
writers to ensure that higher-level cognitive skills are tested. Test bank multiple
choice questions include questions on content but also include many questions
that require analysis, synthesis, and evaluation skills.
xxii
 • Annotated slides: The authors have prepared a comprehensive collection of
50 PowerPoint slides to be used in your lectures. Many of these slides are the same
as Ken Laudon uses in his MIS classes and executive education presentations. Each
of the slides is annotated with teaching suggestions for asking students questions,
developing in-class lists that illustrate key concepts, and recommending other firms as
examples in addition to those provided in the text. The annotations are like an instruc-
tor’s manual built into the slides and make it easier to teach the course effectively.

Student Learning Focused

Student Learning Objectives are organized around a set of study questions to focus stu-
dent attention. Each chapter concludes with a Review Summary and Review Questions
organized around these study questions, and each major chapter section is based on a
Learning Objective.

Career Resources
The instructor resources for this text include extensive career resources, including
job-hunting guides and instructions on how to build a digital portfolio demonstrating
the business knowledge, application software proficiency, and Internet skills acquired
from using the text. The portfolio can be included in a résumé or job application or
used as a learning assessment tool for instructors.

INSTRuCTOR RESOuRCES
At the Instructor Resource Center, www.pearsonhighered.com/irc, instructors can
easily register to gain access to a variety of instructor resources available with this
text in downloadable format.
If assistance is needed, our dedicated technical support team is ready to help with
the media supplements that accompany this text. Visit http://247.pearsoned.com for
answers to frequently asked questions and toll-free user support phone numbers.
The following supplements are available with this text:
• Instructor’s Resource Manual
• Test Bank
• TestGen® Computerized Test Bank
• PowerPoint Presentation
• Image Library
• Lecture Notes

Video Cases and Instructional Videos

Instructors can download step-by-step instructions for accessing the video cases
from the Instructor Resources Center. All Video Cases and Instructional Videos are
listed at the beginning of each chapter as well as in the Preface.

Learning Tracks Modules

Forty-seven Learning Tracks in MyMISLab provide additional coverage topics for
students and instructors. See page xxv for a list of the Learning Tracks available for
this edition.

xxiii
Video Cases and Instructional Videos
Chapter
Chapter 1: Business Information Systems
in Your Career
Chapter 2: Global E-Business and
Collaboration
Chapter 3: Achieving Competitive
Advantage with Information Systems
Chapter 4: Ethical and Social Issues
in Information Systems
Chapter 5: IT Infrastructure:
Hardware and Software
Chapter 6: Foundations of Business
Intelligence: Databases and Information
Management
Chapter 7: Telecommunications, the
Internet, and Wireless Technology
Chapter 8: Securing Information Systems
Chapter 9: Achieving Operational
Excellence and Customer Intimacy:
Enterprise Applications
Chapter 10: E-Commerce: Digital Markets,
Digital Goods
Chapter 11: Improving Decision Making
and Managing Knowledge
Chapter 12: Building Information Systems
and Managing Projects
xxiv
Video
Case 1: UPS Global Operations with the DIAD
Case 2: Google Data Center Efficiency Best Practices
Instructional Video 1: Green Energy Efficiency in a Data Center Using Tivoli
Architecture (IBM)
Instructional Video 2: Tour IBM’s Raleigh Data Center
Case 1: Walmart’s Retail Link Supply Chain
Case 2: CEMEX - Becoming a Social Business
Instructional Video 1: US Foodservice Grows Market with Oracle CRM on Demand
Case 1: National Basketball Association: Competing on Global Delivery with Akamai OS Streaming
Case 2: IT and Geo-Mapping Help a Small Business Succeed
Case 3: Materials Handling Equipment Corp: Enterprise Systems Drive Corporate Strategy
for a Small Business
Instructional Video 1: SAP BusinessOne ERP: From Orders to Final Delivery and Payment
Case 1: What Net Neutrality Means for You
Case 2: Facebook Privacy: Social Network Data Mining
Case 3: Data Mining for Terrorists and Innocents
Instructional Video 1: Viktor Mayer Schönberger on the Right to Be Forgotten
Case 1: Rockwell Automation Fuels the Oil and Gas Industry with the Internet of Things
Case 2: ESPN.com: Getting to eXtreme Scale on the Web
Instructional Video 1: IBM Blue Cloud Is Ready-to-Use Computing
Case 1: Dubuque Uses Cloud Computing and Sensors to Build a Smarter City
Case 2: Brooks Brothers Closes in on Omnichannel Retail
Case 3: Maruti Suzuki Business Intelligence and Enterprise Databases
Case 1: Telepresence Moves Out of the Boardroom and into the Field
Case 2: Virtual Collaboration with Lotus Sametime
Case 1: Stuxnet and Cyberwarfare
Case 2: Cyberespionage: The Chinese Threat
Case 3: IBM Zone Trusted Information Channel
Instructional Video 1: Sony PlayStation Hacked; Data Stolen from 77 Million Users
Instructional Video 2: Zappos Working to Correct Online Security Breach
Instructional Video 3: Meet the Hackers: Anonymous Statement on Hacking Sony
Case 1: Workday: Enterprise Cloud Software-as-a-Service (SaaS)
Case 2: Evolution Homecare Manages Patients with Microsoft Dynamics CRM
Instructional Video 1: GSMS Protects Patients by Serializing Every Bottle of Drugs
Case 1: Groupon: Deals Galore
Case 2: Etsy: A Marketplace and Community
Case 3: Ford Manufacturing Supply Chain: B2B Marketplace
Case 1: How IBM’s Watson Became a Jeopardy Champion
Case 2: Alfresco: Open Source Document Management and Collaboration
Case 3: FreshDirect Uses Business Intelligence to Manage Its Online Grocery
Case 4: Business Intelligence Helps the Cincinnati Zoo
Instructional Video 1: Analyzing Big Data: IBM Watson: After Jeopardy
Case 1: IBM: BPM in a Service-Oriented Architecture
Case 2: IBM Helps the City of Madrid with Real-Time BPM Software
Instructional Video 1: BPM: Business Process Management Customer Story
Instructional Video 2: Workflow Management Visualized
Learning Tracks
Chapter
Chapter 1: Business Information Systems
in Your Career
Chapter 2: Global E-Business and
Collaboration
Chapter 3: Achieving Competitive
Advantage with Information Systems
Chapter 4: Ethical and Social Issues
in Information Systems
Chapter 5: IT Infrastructure: Hardware
and Software
Chapter 6: Foundations of Business
Intelligence: Databases and Information
Management
Chapter 7: Telecommunications,
the Internet, and Wireless Technology
Chapter 8: Securing Information Systems
Chapter 9: Achieving Operational
Excellence and Customer Intimacy:
Enterprise Applications
Chapter 10: E-Commerce: Digital
Markets, Digital Goods
Chapter 11: Improving Decision Making
and Managing Knowledge
Chapter 12: Building Information Systems
and Managing Projects
Learning Tracks
How Much Does IT Matter?
The Changing Business Environment for IT
The Business Information Value Chain
The Mobile Digital Platform
Occupational and Career Outlook for Information Systems Majors 2012–2020
Systems from a Functional Perspective
IT Enables Collaboration and Teamwork
Challenges of Using Business Information Systems
Organizing the Information Systems Function
Challenges of Using Information Systems for Competitive Advantage
Primer on Business Process Design and Documentation
Primer on Business Process Management
Developing a Corporate Code of Ethics for IT
How Computer Hardware and Software Work
Service Level Agreements
Cloud Computing
The Open Source Software Initiative
The Evolution of IT Infrastructure
Technology Drivers of IT Infrastructure
Fourth Generation Languages
Database Design, Normalization, and Entity-Relationship Diagramming
Introduction to SQL
Hierarchical and Network Data Models
Broadband Network Services and Technologies
Cellular System Generations
Wireless Applications for Customer Relationship Management, Supply Chain
Management, and Health Care
Introduction to Web 2.0
LAN Topologies
The Booming Job Market in IT Security
The Sarbanes-Oxley Act
Computer Forensics
General and Application Controls for Information Systems
Management Challenges of Security and Control
Software Vulnerability and Reliability
SAP Business Process Map
Business Processes in Supply Chain Management and Supply Chain Metrics
Best-Practice Business Processes in CRM Software
E-Commerce Challenges: The Story of Online Groceries
Build an E-Commerce Business Plan
Hot New Careers in E-Commerce
E-Commerce Payment Systems
Building an E-Commerce Website
Building and Using Pivot Tables
The Expert System Inference Engine
Challenges of Knowledge Management Systems
Capital Budgeting Methods for Information Systems Investments
Enterprise Analysis: Business Systems Planning and Critical Success Factors
Unified Modeling Language
Information Technology Investments and Productivity
xxv
 Acknowledgements
The production of any book involves valued contributions from a number of persons.
We would like to thank all of our editors for encouragement, insight, and strong sup-
port for many years. We thank our editor Nicole Sam, Program Manager Denise
Weiss, and Project Manager Karalyn Holland for their role in managing the project.
We remain grateful to Bob Horan for all his years of editorial guidance.
Our special thanks go to our supplement authors for their work, including the
following MyLab content contributors: John Hupp, Columbus State University;
Robert J. Mills, Utah State University; J.K. Sinclaire, Arkansas State University; and
Michael L. Smith, SUNY Oswego. We are indebted to Robin Pickering for her assis-
tance with writing and to William Anderson and Megan Miller for their help during
production. We thank Diana R. Craig for her assistance with database and software
topics.
Special thanks to colleagues at the Stern School of Business at New York University;
to Professor Werner Schenk, Simon School of Business, University of Rochester; to
Professor Mark Gillenson, Fogelman College of Business and Economics, University of
Memphis; to Robert Kostrubanic, CIO and Director of Information Technology Services
Indiana-Purdue University Fort Wayne; to Professor Lawrence Andrew of Western
Illinois University; to Professor Detlef Schoder of the University of Cologne; to Professor
Walter Brenner of the University of St. Gallen; to Professor Lutz Kolbe of the University of
Gottingen; to Professor Donald Marchand of the International Institute for Management
Development; and to Professor Daniel Botha of Stellenbosch University who provided
additional suggestions for improvement. Thank you to Professor Ken Kraemer, University
of California at Irvine, and Professor John King, University of Michigan, for more than a
decade’s long discussion of information systems and organizations. And a special remem-
brance and dedication to Professor Rob Kling, University of Indiana, for being my friend
and colleague over so many years.
We also want especially to thank all our reviewers whose suggestions helped improve
our texts. Reviewers for this edition include the following:
Brad Allen, Plymouth State University
Dawit Demissie, University of Albany
Anne Formalarie, Plymouth State University
Bin Gu,University of Texas–Austin
Essia Hamouda, University of California–Riverside
Linda Lau, Longwood University
Kimberly L. Merritt, Oklahoma Christian University
James W. Miller, Dominican University
Fiona Nah, University of Nebraska–Lincoln
M. K. Raja, University of Texas Arlington
Thomas Schambach, Illinois State University
Shawn Weisfeld, Florida Institute of Technology
K.C.L.
J.P.L.

xxvi
Information Systems in
the Digital Age
I
P A R T

1 Business Information Systems in Your Career

2 Global E-Business and Collaboration

3 Achieving Competitive Advantage with Information

Systems

4 Ethical and Social Issues in Information Systems

Part I introduces the major themes and the problem-solving approaches

that are used throughout this book. While surveying the role of information

systems in today’s businesses, this part raises a series of major questions:

What is an information system? Why are information systems so essential

in businesses today? How can information systems help businesses become

more competitive? What do I need to know about information systems to

succeed in my business career? What ethical and social issues do widespread

use of information systems raise?

1
 Business Information
Systems in Your Career
1
C h A p t E r

LearnIng ObjectIves
after reading this chapter, you will be able to answer the following questions:

1-I Why are information systems so essential for running and managing a business today?
1-2 What exactly is an information system? How does it work? What are its people,
organizational, and technology components?
1-3 How will a four-step method for business problem solving help you solve information
system-related problems?
1-4 How will information systems affect business careers, and what information systems
skills and knowledge are essential?

ChAptEr CASES VIDEo CASES

The San Francisco Giants Keep Winning
with Information Technology
The Mobile Pocket Office
UPS Competes Globally with Information
Technology
Home Depot Renovates Itself with New
Systems and Ways of Working
Case 1: UPS Global Operations with the DIAD
Case 2: Google Data Center Efficiency Best
Practices
Instructional Videos
Green Energy Efficiency in a Data Center,
Using Tivoli Architecture (IBM)
Tour IBM’s Raleigh Data Center

2
The SAn FRAnciSco GiAnTS KeeP WinninG
WiTh inFoRmATion TechnoloGy

the San Francisco Giants have won the most games of any team in the history
of American baseball. They have captured 23 National League pennants and ap-
peared in 20 World Series competitions—both records in the National League.
The Giants have outstanding players (with the most Hall of Fame players in all of
professional baseball) and coaches, but some of their success, both as a team and
as a business, can be attributed to their use of information technology.
Baseball is very much a game of statistics, and all the major teams are con-
stantly analyzing their data on player performance and optimal positioning on
the field, but the Giants are doing more. They have started to use a video sys-
tem from Sportsvision called Fieldf/x, which digitally records the position of all
players and hit balls in real time. The system generates defensive statistics such
as the difficulty of a catch and the probability of a particular fielder making
that catch. Information the system produces on player speed and response time,
such as how quickly an outfielder comes in for a ball or reacts to line drives,
enables the Giants to make player data analysis much more precise. In some
cases, it provides information that didn’t exist before on players’ defensive skills
and other skills. Fieldf/x generates a million records per game. That amounts to
5 billion records in three years, the length of time required to provide a high
level of confidence in the data. In addition to player and team statistics, the
Giants are starting to collect data about fans, including ticket purchases and
social media activity.

© Cynthia Lindow/Alamy.

3
4 Part I: Information systems in the Digital age

Under the leadership of chief information officer (CIO) Bill Schlough, the San
Francisco Giants have pioneered in dynamic ticket pricing, based on software from
Qcue, in which the price of a ticket fluctuates according to the level of demand for
a particular ball game. It’s similar to the dynamic ticket pricing used in the airline
industry. If a game is part of a crucial series, the Giants are playing an in-division
rival, or the game appears to be selling out especially fast, ticket prices will rise. If
the game isn’t a big draw, ticket prices fall. Since implementing dynamic pricing, the
Giants have increased ticket sales 7 percent each year.
Season ticket-holders don’t normally attend every game, and this can lose revenue
for a team. Every time a fan with a season ticket decides to stay home from a game,
the sports franchise loses an average of $20 in concession and merchandise sales.
To make sure stadium seats are always filled, the Giants created a secondary online
ticket market on which season ticket holders can resell tickets they are not using. The
Giants’ information technology specialists found a way to activate and deactivate the
bar codes on tickets so that they can be resold. The system is also a way for the Giants
to provide additional service to customers.
The Giants have also taken advantage of wireless technology to enhance their
fans’ experience. A network extends from the seats to the concession stands to areas
outside the stadium and is one of the largest public wireless networks in the world.
The stadium, AT&T Park, has a giant high-speed wireless network, which fans
can use to check scores and video highlights, update their social networks, and do
email.
Sources: Ed Burns, “Data Analytics Applications Let Teams Call New Ticket-pricing Plays,” Search Business
Analytics, March 19, 2015; www/qcue.net, accessed March 5, 2015; http://www.sportvision.com, accessed
March 5, 2015; http://mlb.mlb.com/sf/team/frontoffice_bios/schlough_bill.jsp, accessed February 1, 2015; Peter
High, “Interview with World Champion San Francisco Giants CIO and San Jose Giants Chairman, Bill Schlough,”
Forbes, February 4, 2013; and Fritz Nelson, “Chief of the Year,” Information Week, December 17, 2012.

T he challenges facing the San Francisco Giants and other baseball teams show why
information systems are so essential today. Major League Baseball is a business as
well as a sport, and teams such as the Giants need to take in revenue from games
to stay in business. Major League Baseball is also a business in which what matters
above all is winning, and any way of using information to improve player perfor-
mance is a competitive edge.
The chapter-opening diagram calls attention to important points this case and
this chapter raise. To increase stadium revenue, the San Francisco Giants developed
a dynamic ticket pricing system designed to adjust ticket prices to customer demand
and to sell seats at the optimum price. The team developed another ticketing sys-
tem that enables existing ticketholders to sell their tickets easily online to someone
else. An additional way of cultivating customers is to deploy modern information
technology at AT&T Park, including a massive Wi-Fi wireless network with interac-
tive services. To improve player performance, the Giants implemented a system that
captures video on players and then uses the data to analyze player defensive statistics,
including speed and reaction times.
Here are some questions to think about: What role does technology play in the
San Francisco Giants’ success as a baseball team? Assess the contributions of the
systems described in this case study.
chapter 1: business Information systems in Your career 5

Business
Challenges

• Highly competitive sport

• Monitor games
and ticket sales • Opportunities from new technology
People
• Revise business
strategyes

• Redesign job Information Business

functions and Organization System Solutions
workflows

Ticketing systems • Increase revenue

• Optimize ticket sales
• Provide secondary ticket market
Performance analysis system
• Fieldf/x • Analyze player and team performance
• Qcue dynamic Technology Interactive Services
ticketing software
• Secondary
ticketing platform
• Wi-Fi network

1-1 Why are information systems so essential

for running and managing a business today?
It’s not business as usual in America, or the rest of the global economy, any more. In
2015, American businesses will invest nearly $600 billion in information systems hard-
ware, software, and telecommunications equipment—about one quarter of all capital
investment in the United States. In addition, they will spend another $400 billion
on business and management consulting and information technology services, much
of which involves redesigning firms’ business operations to take advantage of these
new technologies. Together, investments in technology and management consult-
ing added up to more than $1 trillion being invested in information systems in 2014.
These expenditures grew at around 4 percent in 2014, far faster than the economy as
a whole (BEA, 2014). Worldwide, expenditures for information technology exceeded
$3.8 trillion (Gartner, 2015).

hoW InformAtIon SYStEmS ArE

trAnSformInG BuSInESS
You can see the results of this spending around you every day by observing how people
conduct business. Cell phones, smartphones, tablet computers, email, and online con-
ferencing over the Internet have all become essential tools of business. In 2015, more
than 118 million businesses had registered dot-com Internet sites. Approximately
227 million adult Americans are online, 170 million people buy something online,
205 million research a product, and 220 million use a search engine. What this means
is that if you and your business aren’t connected to the Internet and wireless networks,
chances are you are not being as effective as you could be (Pew Internet and American
Life, 2015; eMarketer, 2015).
Despite the economic downturn, in 2014 FedEx moved more than one billion
packages in the United States, mostly overnight, and United Parcel Service (UPS)
moved more than 4 billion packages, as businesses sought to sense and respond to
rapidly changing customer demand, reduce inventories to the lowest possible levels,
and achieve higher levels of operational efficiency. The growth of e-commerce has
had a significant impact on UPS’s shipping volume; UPS delivers about 42 percent
6 Part I: Information systems in the Digital age

of all e-commerce shipments, representing about 22 percent of its revenue. Supply

chains have become faster paced, with companies of all sizes depending on the deliv-
ery of just-in-time inventory to help them compete. Companies today manage their
inventories in near real time to reduce their overhead costs and get to market faster.
If you are not part of this new supply chain management economy, chances are your
business is not as efficient as it could be.
As newspaper readership continues to decline, 150 million people read at least
some of their news online, 110 million read actual newspapers online, and 180 million
use a social networking site such as Facebook, Tumblr, or Google+. More than
135 million bank online, and around 79 million now read blogs, creating an explo-
sion of new writers, readers, and new forms of customer feedback that did not exist
before. At 39 of the top 50 news sites, more than half of the visitors come from mobile
devices. Adding to this mix of new social media, about 300 million people worldwide
use Twitter (about 60 million in the United States), including 80 percent of Fortune
500 firms communicating with their customers. This means your customers are em-
powered and able to talk to each other about your business products and services. Do
you have a solid online customer relationship program in place? Do you know what
your customers are saying about your firm? Is your marketing department listening?
E-commerce and Internet advertising spending will reach $58 billion in 2015,
growing at around 15 percent at a time when traditional advertising and commerce
have been flat. Facebook’s ad revenue hit $12 billion in 2014, and Google’s online ad
revenues surpassed $60 billion in 2014. Is your advertising department reaching this
new web-based customer?
New federal security and accounting laws require many businesses to keep email
messages for 5 years. Coupled with existing occupational and health laws requiring
firms to store employee chemical exposure data for up to 60 years, these laws are spur-
ring the growth of digital information now estimated to be 1.8 zettabytes (1.8 trillion
gigabytes), equivalent to more than 50,000 Libraries of Congress. This trove of infor-
mation is doubling every year thanks in part to more than 200 billion Internet sensors
and data generators. Does your compliance department meet the minimal require-
ments for storing financial, health, and occupational information? If they don’t, your
entire business may be at risk.
Briefly, it’s a new world of doing business, one that will greatly affect your future
business career. Along with the changes in business come changes in jobs and careers.
No matter whether you are a finance, accounting, management, marketing, operations
management, or information systems major, how you work, where you work, and how
well you are compensated will all be affected by business information systems. The
purpose of this book is to help you understand and benefit from these new business
realities and opportunities.

WhAt’S nEW In mAnAGEmEnt InformAtIon SYStEmS?

Lots! What makes management information systems the most exciting topic in busi-
ness is the continual change in technology, management use of the technology, and the
impact on business success. New businesses and industries appear, old ones decline,
and successful firms are those that learn how to use the new technologies. Table 1.1
summarizes the major new themes in business uses of information systems. These
themes will appear throughout the book in all the chapters, so it might be a good idea
to take some time now to discuss these with your professor and other students.
In the technology area are three interrelated changes: (1) the mobile digital plat-
form composed of smartphones and tablet devices, (2) the growing business use of
big data, including the Internet of Things (IoT) driven by billions of data-producing
sensors, and (3) the growth in cloud computing, by which more and more business
software runs over the Internet.
chapter 1: business Information systems in Your career 7

change
Technology
Cloud computing platform emerges as
a major business area of innovation
Big data and the Internet
of Things (IoT)
A mobile digital platform emerges
to compete with the PC as a business
system
TABle 1.1
Business impact
What’s new in MIs
A flexible collection of computers on the Internet begins to perform
tasks traditionally performed on corporate computers. Major business
applications are delivered online as an Internet service (software as a
service [SaaS]).
Businesses look for insights in huge volumes of data from web traffic,
email messages, social media content, and Internet-connected
machines (sensors).
The Apple iPhone and Android mobile devices can download hundreds
of thousands of applications to support collaboration, location-based
services, and communication with colleagues. Small tablet computers,
including the iPad, Samsung Galaxy, and Kindle Fire, challenge conven-
tional laptops as platforms for consumer and corporate computing.

ManageMenT
Managers adopt online collaboration
and social networking software to
improve coordination, collaboration,
and knowledge sharing.
Business intelligence applications
accelerate.
Virtual meetings proliferate.
More than 100 million business professionals worldwide use Google
Apps, Google Drive, Microsoft SharePoint, and IBM Connections to
support blogs, project management, online meetings, personal profiles,
and online communities.
More powerful data analytics and interactive dashboards provide real-
time performance information to managers to enhance decision making.
Managers adopt telepresence, video conferencing, and web conferenc-
ing technologies to reduce travel time and cost, improving collaboration
and decision making.

organizaTions
Social business Businesses use social networking platforms, including Facebook, Twitter,
Instagram, and internal corporate social tools, to deepen interactions
with employees, customers, and suppliers. Employees use blogs, wikis,
email, texting, and messaging to interact in online communities.
Telework gains momentum in the The Internet, wireless laptops, smartphones, and tablet computers
workplace. make it possible for growing numbers of people to work away from
the traditional office. Fifty-five percent of U.S. businesses have some
form of remote work program.
Co-creation of business value Sources of business value shift from products to solutions and
experiences and from internal sources to networks of suppliers and
collaboration with customers. Supply chains and product development
become more global and collaborative; customer interactions help
firms define new products and services.

IPhones, Android phones, and high-definition tablet computers are not just
gadgets or entertainment outlets. They represent new emerging computing and
media platforms based on an array of new hardware and software technologies.
More and more business computing is moving from PCs and desktop machines to
these mobile devices. Managers are increasingly using these devices to coordinate
work, communicate with employees, and provide information for decision mak-
ing. In 2015, more than 60 percent of Internet users will access the web through
mobile devices. To a large extent, these devices change the character of corporate
computing.
Another random document with
no related content on Scribd:
transversely, the vessels of the lumbar region are compelled to describe a
somewhat prolonged vertical course before reaching their point of
distribution. From these circumstances, even transitory congestions in the
circulation of the cord are easily followed by irreparable injury of its
delicate elements.
133 Loc. cit., Path. Trans., 1884.

Finally, in all discussions on pathogeny must not be forgotten the doctrine

of Leyden134 that infantile paralysis, also progressive muscular atrophy, is
a disease which may begin at the periphery and extend to the centres, as
well as the reverse. It must also be remembered that, as yet, only very
scanty evidence exists to support this, in itself, plausible theory.
134 See loc. cit., ut supra.

COURSE OF INFANTILE PARALYSIS.—The most ordinary course of infantile

paralysis is that already described as typical—namely, extremely rapid
development to a maximum degree of intensity, then apparent
convalescence, retrocession of paralysis, atrophy, and ultimate
deformities in limbs in which paralysis persists.

Several variations from this typical course are observed. Complete

recovery may take place, as in the so-called temporary paralysis of
Kennedy135 and of Frey.136 These cases are very rare. But their possibility
seriously complicates the estimate we may make of the efficacy of
therapeutic measures.137
135 Dublin Quarterly Journal, 1840.

136 Berlin. Klin. Wochensch., 1874. I have described one such temporary case in the article
already quoted. These cases seem about as frequent in adults. (See Frey, loc. cit.; also case
of Miles, etc. etc.)

137 As of the case of complete recovery, the only one the author had seen, related by Dally,
Journal de Thérap., 1880, 1, vii.

On the other hand, there may be a complete absence of regression; and

this is observed sometimes in cases where the paralysis is originally
limited; sometimes where it is extremely extensive, involving nearly all the
muscles of the trunk or limbs;138 or muscles or limbs originally spared may
become involved in a fresh attack. Laborde relates cases of this kind. In
Roger's first case paraplegia occurred under the influence of scarlatina
two months after paralysis of one arm.
138 Thus in Eulenburg's case, quoted ut supra.

The form of anterior poliomyelitis most frequent in adults is the subacute,

and after that the chronic. Both are extremely rare in children, the latter
excessively so. Seeligmüller and Seguin139 both admit the possibility of a
chronic form in children, and the latter has kindly communicated to me
one case from his private practice:

Miss N. D——, æt. 15, paresis in both legs, first at age of nine, increased
at age of twelve, when weakness of vision first noted. At fourteen both
feet in rigid pes equinus, and both tendons achilleis cut, without benefit.
Hands became tremulous, without paresis. On examination at age of
fifteen found moderate atrophy of muscles of both legs. Tendo Achillis
united on both sides, and equinus persists. Voluntary movement exists,
both in anterior tibial and in gastrocnemius muscles, but diminished in
anterior tibial. Faradic contractility diminished in both sets of muscles;
examination difficult from extreme sensibility of patient. In both hands
interossei, muscles of thumb, and little finger show tremors and fibrillary
contractions. Thenar eminences small, abductor pollicis nearly absent,
not reacting to faradic current. Optic nerves slightly atrophied. Mind
enfeebled, memory poor; articulation not affected. Five years later the
motor paralysis and mental enfeeblement had still further progressed, but
no exact notes exist of this period.
139 Loc. cit. (ed. 1877).

Erb140 relates a case that he considers unique at the time in a girl of six.
The paralysis began insidiously in the right foot in July; a fortnight later
had extended to the left foot; complete motor paralysis existed in August,
without any lesion of sensibility: after electrical treatment, then instituted,
first return to motility to peroneal muscles in November; by January child
able to walk again and electrical reactions nearly normal.141
140 Brain, 1883.

141 In the same number of Brain, A. Hughes Bennett quotes cases of so-called chronic
paralysis in very young children which are evidently cases of general paresis from congenital
 cerebral atrophy. The children were defective in intelligence, could not sit up nor hold up the
head; the electrical reactions were preserved. I have seen a great many such cases: they
are indeed not at all uncommon. Much more so is Bennett's diagnosis.

COMPLICATION WITH PROGRESSIVE MUSCULAR ATROPHY.—Raymond142 and

Seeligmüller describe some rare cases where progressive muscular
atrophy declared itself in persons previously affected with infantile
paralysis in other limbs. Both observers infer a gradual and chronic
extension along the cord of the originally acute anterior poliomyelitis.143
Similar cases have much more recently (1884) been quoted by Ballet as
tending to modify the prognosis which has usually been pronounced
favorable quoad life and further spinal accidents. (See infra.)
142 Gaz. méd., 1875. No. 17.

143 It seems to me that Seguin's case, above quoted, might be an example of such
complication(?). But I have not seen the patient myself, and describe the case according to
the views of the author.

PROGNOSIS.—The prognosis of atrophic paralysis, quoad vitam, is, as is

well known, extremely good. The prospect of recovery from the paralysis
is variable. It cannot be estimated either by the extent of the initial
paralysis or by the severity of the fever or attendant nervous symptoms.
The electrical reactions alone are of value in the prognosis, and their
value is very great. Duchenne first formulated their law: “All the cases of
infantile paralysis which I have seen where the faradic contractility was
diminished but not lost, and which could be treated by faradic electricity
within two years after the onset of the paralysis, have completely
recovered.”144 This encouraging statement must be read as applying
rather to individual muscles than to cases as a whole. Few complete
recoveries of patients are claimed even by so enthusiastic an electrician
as Duchenne; who nevertheless affirms his not unfrequent success in re-
creating entire muscles out of a few fibres saved from degeneration.
144 Loc. cit.

The persistence of galvanic irritability in muscles which fail to contract to

the faradic current has been shown by Erb to belong to the degenerative
reactions. Hammond, however, without alluding to the qualitative changes
in the galvanic contractions, sees in them the elements of a relatively
favorable prognosis, even when faradic contractility is lost. Thus, out of
87 cases, in 39 of which the paralyzed muscles contracted to the galvanic
but not the faradic current, 14 were entirely cured, 28 greatly improved,
30 slightly improved, 15 discontinued treatment very early.145
145 Loc. cit., p. 482.

Examination of fragments of living muscle obtained by Duchenne's

harpoon, though useful, should not be allowed to exaggerate an
unfavorable prognosis. Much fat may be found in such fragments when
the muscle is as yet by no means completely degenerated and can be
made to contract to one or the other current. Erb, however, admits that
the results of treatment have not, in his hands, been brilliant; but adds
that he has had no opportunity to treat any cases which were not of long
standing.146
146 Loc. cit.

Volkmann147 considers the paralysis entirely hopeless, and advises the

concentration of all effort upon the prevention or palliation of deformities.
147 Loc. cit.

It seems probable that at the present moment sufficient data do not exist
for formulating a fair prognosis; nor will they until a much larger number of
cases than hitherto have been submitted to all the resources of a complex
and persevering system of therapeutics from the earliest period of the
disease.

SPECIAL PARALYSES.—Among the paralyses, some exercise a more

unfavorable influence on locomotion than others. Thus, paralysis of the
muscles of the trunk is more difficult to palliate, either by apparatus or by
the efforts of the patient, than any paralysis of the limbs. Similarly,
paralysis of the upper segments of a limb is more crippling than when
confined to the lower. Partial paralysis of the muscles surrounding a joint
is often (but not always) more liable to lead to deformity than total
paralysis.

Influence of Neglect.—Apart from the influence of treatment in curing the

paralysis, must be estimated in the prognosis the effect of care and
watchfulness in limiting the disease and in averting many consequences,
even of those which are incurable. The rescue of muscles only partially
degenerated may often serve to compensate the inaction of those which
are irretrievably ruined.

Ballet148 has recently called attention to the fact that in certain cases
persons who had been attacked with an anterior poliomyelitis in childhood
became predisposed to different forms of spinal disease. Four have been
observed: (1) transitory congestion of the cord, causing paralysis of a day
or two's duration; (2) an acute spinal paralysis of the form usually seen in
adults; (3) subacute spinal paralysis; (4) progressive muscular atrophy.
The author relates cases under each of these heads, and further quotes
one related by Dejerine in 1882.149 The patient, a carpenter aged fifty-five
and with an atrophic deformity of the foot, became suddenly paralyzed in
the four limbs, trunk, and abdomen. The paralysis was complete in a
month, was stationary for three months, then began to improve, and at
the end of six months from the onset of the disease recovery was
complete.
148 Revue de Médecine, 1884.

149 Revue de Médecine, 1882.

The observations of progressive muscular atrophy in persons bearing the

stigmata of an infantile paralysis are quite numerous.150
150 Charcot, Soc. Biol., 1875, and Gaz. méd.; Seeligmüller (4 cases), in Gerhardt's
Handbuch, 1880; Hayem, Bull. Soc. de Biol., 1879; Vulpian, Clinique méd. de la Charité,
1879; Pitres, new observation, quoted by Ballet in 1884.

The prognosis cannot be the same for cases where everything is done to
avert malpositions and for those where all precautions are neglected.
Thus, prolonged rest in bed favors pes equinus; the use of crutches
necessitates flexion of the thigh and forced extension of the foot;
locomotion without support tends to displace articulations by
superincumbent weight, causing pes calcaneus, genu-recurvatum. Finally,
compensatory deformities must be averted from sound parts, as scoliosis
from shortening of the atrophied leg, equinus from passive shortening of
the gastrocnemii through flexion of the leg, etc.

ETIOLOGY.—Concerning the etiology proper of infantile paralysis little

definite is known. It is probable, as has been already noticed, that
traumatisms have a much more decided influence than is generally
assigned to them. Leyden particularly insists on this influence, and on the
facility with which a traumatism relatively severe for a young child may be
overlooked, because it would not be recognized as such for an adult. It
must be noticed, however, that children are much more liable to have the
arms wrenched and pulled violently than the lower extremities; yet in a
great majority of cases the lesion is situated in the lumbar cord.

It has been shown that the myelitis, though so limited transversely, is

often far more diffused in the longitudinal axis of the cord than might be
supposed from the permanent paralyses. This fact corresponds to the
initial generalization of the motor disturbance. It seems possible that the
traumatic irritation, starting from the central extremity of the insulted
nerve, diffuses itself through the cord until it meets with its point of least
resistance, and here excites a focal myelitis. That this point should most
frequently be found in the lumbar cord would be explained by its relatively
less elaborate development, corresponding to the imperfect growth and
function of the lower extremities.

A second cause of anterior poliomyelitis is, almost certainly, the presence

of some poison circulating in the blood. The frequent occurrence of the
accident in the course of one of the exanthemata is one indication of this;
other indications are found in such cases as that related by Simon, where
three children in one family were suddenly attacked—two on one day,
one, twenty-four hours later.151 The same author relates a case of motor
paralysis in an adult, followed by atrophy of left lower extremity, and which
occurred during a fit of indigestion caused by eating mussels.152 The
acute ascending paralysis of Landry, with its absence of visible lesion,
has been said to strikingly resemble the effects of poison. Hydrophobia
and tetanus are again examples of the predilection exhibited by certain
poisons for the motor regions of the cord.
151 Journal de Thérap., 7, vii., 1880, p. 16. These children belonged to an American family,
but were seen by several distinguished French physicians.

152 P. 357.

The evidence that infectious diseases may constitute the immediate

(apparent) causal antecedent of acute poliomyelitis has led, not
unnaturally, to the theory that all cases of acute infantile paralysis are due
to a specific infecting agent, some as yet unknown member of the great
class of pathogenic bacteria. It may be noticed, however, that the
occurrence of the spinal accidents after the ordinary infectious diseases,
as scarlatina and measles, should as well indicate that a specific agent
proper to itself was at least not essential to its development.153
153 Perhaps the occurrence of diphtheria in the course of scarlatina and typhoid should
indicate a similar lack of real specificity in the morbid agent of the former disease.

The influence of exposure to cold, which seems to have been sometimes

demonstrated, must probably be interpreted, as in the case of
rheumatism and pneumonia, as effective by means of some poison
generated in the organism when cutaneous secretion, exhalation, or
circulation has been suddenly checked.

DIAGNOSIS.—The diagnosis of the acute anterior poliomyelitis of childhood

is usually easy, but unexpected difficulties occasionally arise.

Typical cases are markedly different from typical cases of cerebral

paralysis, but in exceptional cases these differences disappear. This is
shown in the following table:

SPINAL PARALYSIS. CEREBRAL PARALYSIS.

Hemiplegic, (rule). Monoplegic as residuum of
Paraplegic or monoplegic (rule). hemiplegia or as consequence of solitary tubercle
(exception).
Hemiplegic as residuum from paraplegia, or
original and involving facial nerve (very
exceptional).
Intelligence free (rule). Intelligence depressed (rule).
Intelligence depressed (when spinal paralysis Intelligence free (exception, especially with solitary
has affected imbecile children). tubercle).
Disposition lively. Disposition apathetic or cross.
Initial convulsion unique; general symptoms Convulsions repeated; pyrexia prolonged several
of a few hours' duration (rule). days or weeks (rule).
Convulsion repeated during two to three
weeks before paralysis; fever a month (rare
exceptions).
Sensibility intact (rule). Sensibility intact after initial period.
Occasional hyperæsthesia (exception).
Reflexes cutaneous, and tenderness lowered
Reflexes intact.
or lost (rule).
Reflexes preserved when only single
muscles in groups paralyzed.
Associated movements of hand absent Associated movements frequently observed in
(Seeligmüller). hand.
Extensive and rigid contractions of upper extremity
No rigid contractions of upper extremity.
very frequent.
Atrophy of paralyzed muscles and arrested
Atrophy very slight.
development of limb, very marked.
Faradic contractility diminished or lost;
Electrical reactions normal.
degenerative galvanic reaction.

Rather singularly, the diagnosis from transverse myelitis is less liable to

error than that from cerebral paralysis:

ANTERIOR
TRANSVERSE MYELITIS.
POLIOMYELITIS.
Fever brief or absent. Persistent fever.
Sensibility intact. Hyperæsthesia, then anæsthesia.
Decubitus absent. Presence decubitus.
Reflexes lost. Reflexes increased.
Atrophy of muscles. Atrophy of muscles sometimes as intense.
Electrical muscular Loss of electrical contractility, but not proportioned to sensory and motor
contractility lost. disturbance; less rapidly completed.

The diagnosis from hæmatomyelitis is almost impossible, and practically

useless. For if the hemorrhage be severe, the child dies at once, as in
Clifford Albutt's case. If less severe, it excites a myelitis, and the history
becomes identical with that of the disease we are considering; or if the
clot beyond the anterior cornua, it is identified with a vulgar myelitis of
traumatic origin.

Progressive muscular atrophy is extremely rare in childhood, but is

occasionally seen under hereditary influence (Friedreich's disease). In
adult cases confusion is not only easy to make, but often difficult to avoid,
especially with the rare, chronic form of poliomyelitis. The basis of
distinction is as follows:
 ANTERIOR POLIOMYELITIS. PROGRESSIVE MUSCULAR ATROPHY.
Onset sudden; maximum of paralysis at the March very gradual; maximum of disease
beginning. not attained for years.
Faradic contractility not lost until atrophy
Faradic contractility lost almost at once.
complete.
Shortening of limbs and atrophy of limbs (in
No arrest of development of limbs.
infantile cases).
Functionally associated muscles frequently Capricious selection of muscles, but frequent
associated in paralysis: hand rarely affected. wasting of these at eminences.

Paralysis from lesion of a peripheric nerve closely imitates anterior spinal

paralysis.154 It is distinguished by closely following the distribution of the
injured nerve, and, usually, by concomitant lesions of the sensibility and of
cutaneous nutrition.
154 The importance of this fact has been shown in the section on Pathogeny. (See also
quotations from Leyden and remarks on lesions of peripheric nerves.)

The pseudo-paralysis sometimes observed in syphilitic children as a

consequence of a gummatous infiltration of the bones at the junction of
the epiphysis and diaphysis155 might easily be mistaken for a spinal
paralysis. But it is an affection peculiar to the new-born; the electrical
reactions of the paralyzed muscles are intact; careful examination will
show that the movements of the muscles are not impossible, but
restrained by pain; often other syphilitic affections are present.
155 Parrot, Wagner.

The diagnosis from diphtheritic paralysis is embarrassed, from the fact

that true anterior poliomyelitis may develop in the course of diphtheria as
of other infectious diseases. The paralysis of the soft palate, preservation
of faradic reaction, absence of atrophy, and the usually rapid recovery
must establish the differentiation.

In spinal paralysis there is loss of the reflexes,156 and also of faradic

contractility, both of which are preserved in hysteria. In hysterical
paralysis, also, there is no wasting of the affected muscles.
156 See Gowers's monograph on “Spinal-Cord Diseases” for an excellent summary of the
spinal reflexes.
Various diseases of the bony skeleton or articulations may simulate spinal
paralysis. Congenital club-foot, caused by unequal development of the
bones and cuticular surfaces, is to be distinguished from the paralytic
variety by the date of its appearance,157 by the deformity of the tarsal
bones, and by the extreme difficulty of reduction.
157 Though in some cases paralysis of the muscles of the foot seems to take place during
fœtal life, and a club-foot result which is both congenital and paralytic.

Caries of the calcaneum, leading the child to walk on the anterior part of
the foot to avoid pressure on the heel, may leave after recovery such a
retraction of the plantar fascia as to cause a degree of equinus and varus,
with apparent paralysis of the peroneal muscles. I have seen one such
case.

Congenital luxation of the hip may simulate paralysis; indeed, by Verneuil,

it has been attributed to an intra-uterine spinal paralysis. There is,
however, no change in the electrical reactions of the muscles surrounding
the joint.

In coxitis, however, Newton Shaffer158 has demonstrated a moderate

diminution of faradic contractility in such muscles, and a corresponding
degree of atrophy; and this fact might complicate the diagnosis of
paralysis from arthritis of the hip-joint. Gibney159 has called attention to
the facility with which this confusion may arise, and Sayre160 relates cases
of infantile paralysis mistaken for coxitis.
158 Archives of Medicine.

159 Am. Journ. Med. Sci., Oct., 1878.

160 Orthopædic Surgery.

In a case observed by myself, which had been previously diagnosed as

coxitis, the mistake was all the more interesting as the paralysis which
really existed seemed to have been caused by a meningitis rather than
primary myelitis of the cornua.161 It thus corresponded to the meningo-
myelitic case related by Leyden.
161 The details of this case are as follows: C. P——, aged 11, ten months previous to
consultation suffered from febrile attack, accompanied by retraction of head, severe pains
 diffused through body and intense at nape of neck; unconsciousness for thirty-six hours;
vomiting; no convulsions. Case diagnosed as cerebro-spinal meningitis by attendant
physician. Convalescence in a week, but with pain in lumbar region of back, predominating
on right side, so aggravated by standing or walking that both acts impossible. Coincidently,
pain in right calf; exquisite tenderness to pressure even from stocking. No complaint in
recumbent position. Child could not get from floor to bed, nor raise right leg from ground. As
pain subsided walking became possible, but right leg dragged. Chronic twitchings on left
side, face, arm, leg. These symptoms lasted ten or twelve weeks, but at end of nine weeks
patient could walk up stairs. In ten months power of walking almost recovered, but there
remained a certain amount of lordosis and oscillation of pelvis, which is jarred on the left
side while the right leg is swung forward. Recumbent, all movements executed equally well
on both sides and passive motion of the hip-joint perfectly free. Circumference of right thigh
and leg diminished from one-half to one inch as compared with the left. Faradic contractility
diminished on the right side in the gluteal muscles, vastus externus, and rectus, and in the
gastrocnemii. The sacro-lumbalis muscle was, unfortunately, not examined, but from the
lordosis was probably affected. The remaining muscles were intact. Pain on pressure
persisted over right side of second, third, and fourth lumbar vertebræ. Diagnosis was made
of a limited meningeal exudation, with compression of anterior part of cord or of a portion of
the lumbar and of the sacral plexus.

Scoliosis, which may be caused by the relatively rare unilateral paralysis

of some of the muscles of the trunk, may also be simulated by paralysis
with shortening of one lower extremity. To compensate the shortening, the
trunk is bent over on the paralyzed side; hence a lateral curvature, easily
reducible, but easily leading into error.

It would seem easy to distinguish traumatic cases of subluxation of the

humerus from those due to paralysis of the deltoid. Yet sometimes only
the history will serve to establish, and that somewhat doubtfully, the
diagnosis.162
162 A child of four was brought to me with a stiffness and rigidity of the shoulder-joint which
could only very partially be overcome by passive motion, and not at all by voluntary effort.
The mother stated that several months previously the child had, without apparent cause,
become suddenly unable to move the arm. After two months' delay it was taken to a
dispensary, and told that the arm was out of joint, and had it reset under ether. From this
date the stiffness had gradually developed. The deltoid was atrophied, with marked
diminution of the faradic contractility. Question: Were these signs merely symptomatic of an
arthritis consequent on a dislocation, or was the latter the result of a spinal paralysis of the
deltoid?
THERAPEUTICS.—The treatment of anterior poliomyelitis embraces two
stages. In the first it is directed against inflammation of the spinal cord
and the paralysis of the muscles; in the second period the spinal lesion
has run its course and the paralysis is considered incurable. Treatment is
then directed to the prevention or palliation of deformities or toward
facilitating the functions of the limb in spite of them.

These two periods are not, however, rigidly separated from each other in
chronological order. From the very outset it is important to take certain
precautions to prevent deformities, and while palliating these with
orthopædic apparatus it is important for years to continue treatment of the
paralyzed muscles in the hope that at least a remnant of them may be
saved. To abandon the case to the orthopædic instrument-maker, or to
neglect the problem of dynamic mechanics while applying electricity and
studying the progress of fatty degeneration, are errors greatly to be
condemned.

The treatment of the initial stage is necessarily purely symptomatic for the
fever and convulsions, since the diagnosis cannot be made out until these
have subsided.

As soon as the diagnosis is clear, however, certain measures should be

adopted to diminish the hyperæmia of the spinal cord. Dally163
recommends the ventral decubitus; almost all modern authorities advise
ice to the spine and ergot internally or subcutaneously. Thus, Althaus164
makes hypodermic injections of ergotin in doses of one-fourth of a grain
for a child between one and two years old; one-third of a grain between
three and five; and one half grain from five to ten; and these doses
repeated once or twice daily. The only objection to this treatment is the
degree of local irritation it can hardly fail to occasion. Hammond, who
“affirms ergot to be of great service, the only medicine capable of cutting
short the disease or of limiting its lesions,” recommends the internal
administration of the fluid extract—ten drops three times a day for infants
of six months, half a drachm for children between one and two years.165
163 Journ. Thérap., t. viii., 1880.

164 On Infantile Paralysis.

 165 I have elsewhere quoted one case of early recovery under the use of ice and ergot; or
was this a case of temporary paralysis?

The belladonna treatment, at one time so warmly praised by Brown-

Séquard, retains to-day few adherents.

Simon advises cutaneous revulsives to divert the circulation to the

surface; thus, hot-air baths, mustard powder sprinkled on cotton
enveloping the limbs. Ross advises mercurial inunction along the spine,
followed by iodine and blisters. At the same time, iodide of potassium
should be given internally in large doses. The action of this drug upon
inflammations of the nerve-centres seems, within certain limits, to be
indisputable, but its mode of action is certainly very obscure. Where the
lesion can be attributed to a meningo-myelitis,166 the iodide may be
expected to facilitate the absorption of the exudation. In these cases it
should be continued for a long time.167
166 As in Leyden's first case, and my own.

167 Binz explains the local action of iodine by an exudation of leucocytes which follows the
dilatation of blood-vessels. These elements break down the exudation into which they are
poured, and thus facilitate its absorption.

Electrical treatment may be begun by the end of the first week after the
paralysis. At this stage Erb recommends central galvanization as an
antiphlogistic remedy for the myelitis. For this purpose a large anode
must be placed over the spine at the presumed seat of the lesion, while
the cathode is applied over the abdomen. By a slight modification of the
method the cathode is placed over the paralyzed muscles. The
application is stabile, and, according to Erb, should last from three to ten
minutes; according to Bouchut, several hours daily. Erb's method is
intended exclusively as a sedative to the local inflammation. When the
cathode is placed on the muscles it is hoped that the descending current,
replacing the lost nervous impulses, may avert the threatening
degeneration of the muscle and nerve.

Faradization cannot modify the inflammatory lesions of the cord. As a

means of averting degeneration in completely paralyzed muscles it is
inferior to galvanism, and should not therefore be used in those muscles
which refuse to contract under its stimulus. Its immense utility, however, is
as a stimulus to muscles imperfectly paralyzed, but liable to degenerate
from inaction and to be overborne by their antagonists. The excitation of
contractions in such muscles is a powerful local gymnastic, helping to
maintain nutrition by artificially-excited function.

For the same purpose, muscles inexcitable to the faradic current should
be, when this is possible, made to contract by the interrupted galvanic
current. After this treatment has been prolonged during several months,
the faradic contractility often returns, and the current then should be
changed (Seguin).

The value of electrical treatment has been very differently estimated. Erb
remarks that “its results are not precisely brilliant.” Roth, whose testimony
perhaps is not above suspicion, since evidently prejudiced, insists that
numerous cases fall into his hands which have submitted for months to
electrical treatment without the slightest benefit. On the other hand,
Duchenne, as is well known, has expressed almost unbounded
confidence in the therapeutic efficacy of faradization, declaring that it was
capable of “creating entire muscles out of a few fibres.”

The sensitiveness of children to the electrical current, and their terror at

its application, seriously interfere with its persistent use; as, if the
patience of the physician is maintained, that of the parents is very likely to
fail in the presence of the cries and resistance of the child.

It is very probable that some of the failures of electrical treatment are due
to the attempt to rely upon it exclusively, instead of suitably combining
both electrical methods with each other and with other remedial
measures. With our present knowledge it is safe to assert the desirability
of persistent electrical treatment during at least the first two years
following the paralysis. The currents must never be too strong—the
faradic, at least, never applied for longer than ten minutes at a time. The
muscles should be relaxed by the position of the limbs (Sayre). If the
muscles continue to waste, and especially if they become fatty, the
electrical response will grow less and less, and finally cease altogether.168
In the contrary case the galvanic contraction will become normal in
quality, and the faradic contractility will return and increase, while the
atrophy is arrested and the muscle regains its bulk and voluntary powers.
Sometimes, as already stated, the latter is regained, while faradic
contractility remains greatly diminished.169
 168 Passing through three stages: faradic contractility diminished, galvanic contraction
increased; faradic response lost, galvanic degenerative; absence of contraction to either
current.

169 Sayre (loc. cit.) has noticed cases in which the muscle would contract several times
under faradism, then refuse to do so for a day or two. This observation, if valid and not due
to unequal working of the battery, is a most curious one.

A succedaneum to electricity that is highly prized by some authorities is

strychnia, especially when subcutaneously administered. Pelione170
relates the cure of two cases in children of four and five years, after three
and four years' duration of the paralysis, by strychnia—one-half
milligramme daily. None should be given to children under six months, but
over that age one-ninety-sixth of a grain may be given (Hammond). It
should not be given subcutaneously more than two or three times a week
(Seeligmüller).171
170 L'Union médicale, 1883.

171 Duchenne relates a case of a paralysis general at the outset and remaining so for six
months. It was then treated by strychnine for five or six months, and at the end of that time
had become limited to the lower extremities (Elect. local., ed. 1861, p. 278).

The incidental action of electricity in attracting blood to the paralyzed

muscles may be sustained by several other methods.

Among these the external application of heat, either dry or in the form of
hot douches, alternating with cold, is an adjuvant remedy of real
importance. Beard has suggested tubing, malleable to the limbs, for the
conduction of hot water. It is desirable to employ massage immediately
after cessation of the hot applications.

On the value of massage and passive gymnastics opinion is even more

variable than in regard to electricity. Roth, a specialist in orthopædics,
places it at the head of all remedial measures, and denounces electricity
in comparison. Many professional manipulators, ignorant of medical
science, continually claim wonderful triumphs over regular physicians
obtained by means of systematized massage. Volkmann, on the other
hand, dismisses the pretensions of the Heilgymnastik with considerable
contempt, declaring that faradization is the only method which can really
secure exercise to paralyzed muscles.
The Swedish movement cure consists in passive movements imparted to
a limb by the manipulator, at the same time that they are strenuously
resisted by the patient. From the nature of this method, and its aim in
stimulating the voluntary innervation of the muscles, it is admirably
adapted to hysterical paralysis. Theoretically, it is difficult to perceive the
applicability of this method in organic atrophic paralysis, especially in
young children, whose voluntary efforts cannot be commanded. There
are, however, several real indications for passive gymnastics in the
treatment of infantile paralysis. Surface friction and deep massage have
some influence in dilating the blood-vessels and causing an afflux of
blood to the cold and wasting muscles. A probably more important effect
may be produced upon the contraction caused by malposition and
adapted atrophy of certain groups of muscles. It is these contractions
which formerly constituted the special objection of the orthopædist, and
were treated almost universally by tenotomy. They are in any case the
proximate cause of deformities; and, generally existing on the side of the
joint opposite to the most severely paralyzed muscles, they keep these
over-stretched and prevent them from receiving the benefit of the
electrical treatment. Muscles which will not contract to the faradic current
while thus stretched will often begin at once to do so when the rigidity of
their antagonists has been overcome.

Persevering stretching by the hands will often overcome this rigidity as

completely, and even more permanently, than will the tenotomy-knife. It is
in this part of the treatment that entirely ignorant and even charlatan
manipulations do, not unfrequently, achieve remarkable results.172
172 Of course many of those on record, and to some of which I have been a witness, relate
to hysterical contractions, hysterical scoliosis, etc.

It is the retracted tendo Achillis and plantar fascia which most frequently
require this manipulation. In the paralytic club-foot of young children all
authorities agree in the value of repeated manipulations and restorations
of the foot as nearly as possible to a position where it may be retained by
simple bandaging. While turning the foot out it becomes perfectly white,
but on releasing hold of it the circulation is restored, after which the
manœuvre may be repeated (Sayre).

This principle of intermittent stretching by seizure of the segments of the

limb above and below the joint applies to all forms of paralytic contraction.
In the trunk the pelvis should be held by the mother, while the
manipulator, seizing the thorax of the child between both hands, moves it
gently but forcibly to and fro in the required direction. Great care is
required in these manipulations—not merely to avoid exhausting the
muscles, but even to avoid fracturing atrophied bones.

It may be laid down as a positive rule that tenotomy should never be

performed in the contractions of spinal paralysis until the resources of
manipulation have been exhausted. It is to be remembered that the
rigidity depends on no active contraction of the muscle, but on its elastic
retraction. The manœuvre of stretching does not appeal to the force of
contractility, which may have been lost, but to the force of elasticity, which
remains and can be made to act in a reverse direction. Finally, in the
cases where the retracted muscles have not been originally paralyzed,
but have lost the power of contracting during the process of shortening,
this power may be restored if the muscle regain its normal length.

The operation of tenotomy, apparently a far more heroic measure, is often

a less efficacious means of arriving at the results. Unless followed by the
application of apparatus which permits motion in the joint, section of
contracted tendons is only of brief utility.

Though the edges of the cut tendon have been kept apart until the
intervening space is filled by new tissue, union is finally effected by the
latter, and retraction through elasticity is again imminent. Often, therefore,
the deformity is repeated in spite of repeated operations; when it is not,
the happy issue is due to the fact that, with increased freedom of
locomotion immediately after the tenotomy, the patient has been enabled
to bring the influence of weight to bear in such a manner as to fix the limb
in a new and more convenient position. Thus, after section of the tendo
Achillis for pes equinus, if the patient begins at once to walk on the
paralyzed foot, the weight of the body, pressing down the heel, may keep
the tendon stretched. So walking immediately after section of the
hamstring muscles will have a tendency to produce genu-recurvation by
the same mechanism which produces it in total paralysis, and the original
deformity will not recur.

Besides the tendo Achillis, the parts which may be occasionally submitted
to tenotomy are the plantar fascia, the peroneal muscles, very rarely the
anterior tibial and extensors, the hamstrings, the thigh adductors. Section
of the external rotators of the thigh or of the tensors of the fascia lata
could hardly ever be required, and among these operations Hueter173
rejects that on the plantar aponeurosis as inadequate. The excavation in
the foot it is designed to remedy depends upon alteration in the form of
the tarsal bones, and can only be cured by means of forcible pressure
exerted on their dorsal surface. Section of the peroneal muscles, often
recommended by Sayre, is considered by Hueter to be superfluous after
section of the tendon achilleis. Paralytic contraction of the hamstrings or
of the hip flexors is rarely sufficiently severe to demand tenotomy.
173 Loc. cit., p. 416.

From what has preceded it is evident that maintenance of locomotion is of

great importance, in order to avoid the deformities which are threatened
by prolonged repose. Locomotion, however, can only be safely permitted
with the assistance of apparatus capable of restraining the movements
liable to be produced by the weight of the body. The supporting
instrument which restrains movement in certain directions must, however,
facilitate it in others: immovable apparatus, such as is not infrequently
applied after tenotomy, is always injurious.

In young children unable to walk, the development of pes equinus may

often be prevented by drawing down the foot to a sole splint made of thin
wood, gutta-percha, or felt, and fastening it with a flannel bandage. The
point of the foot may be drawn up toward the tibia by a strip of diachylon
plaster. If the equinus has already developed, a splint of gutta-percha or
of felt (Sayre) may be modelled to the leg and foot while the latter is held
forcibly in dorsal flexion. The splint is attached by means of strips of
adhesive plaster. It should extend as far as the knee, and be suitably
padded (Seeligmüller).

In children able to walk a sole splint of thin metal, to which the foot had
been previously attached by a flannel band, should be inserted in a stout
leather boot. On the outer side of this boot should run a metallic splint,
jointed at the ankle and extending to a leather band surrounding the leg
just below the knee. A broad leather band, attached to the outer edge of
the sole anterior to the talo-tarsal articulation, also passes up on the
outside of the foot, gradually narrowing until, opposite the ankle, it passes
through a slit in the side of the shoe, to be attached to the leg-splint. This
band tends to draw the point of the foot outward, and thus correct the
varus (Volkmann). Sayre174 has improved on this shoe by dividing the sole
at the medio-tarsal articulation, in which lateral deviation takes place, and
uniting the anterior and posterior parts by a ball-and-socket joint,
permitting movement in every direction.
174 Loc. cit., p. 88.

The orthopædic boot for the treatment of calcaneo-valgus is constructed

on the same principle. But the splint runs up the inner side of the leg, and
the leather strap passing to it from the edge of the sole draws the point of
the foot inward and raises its depressed inner border (Volkmann).
Essential to the treatment of this deformity, however, is the elevation of
the heel. This is effected by means of a gutta-percha strap which is
attached below to a spur projecting from the heel of the shoe, and above
to a band encircling the leg. If, by rare exception, a paralytic calcaneus
exists in a child unable to walk, a simple substitute may be found for the
shoe in a board sole-splint projecting behind the heel, attached to the foot
by a strip of adhesive plaster, which finally passes from the posterior
extremity of the board up the back of the leg, and is there secured by a
roller bandage.

The device of the gutta-percha elastic band to replace the gastrocnemius

muscle illustrates a principle of wide application in orthopædic apparatus.
The suggestion to replace paralyzed muscles by artificial ones was first
made by Delacroix175 in an apparatus designed for the hand. The
suggestion was repeated by Gerdy;176 and in 1840, Rigal de Gaillac
proposed to exchange the metallic springs hitherto used for India-rubber
straps. Duchenne elaborated the suggestion in a remarkable manner,177
using delicate spiral springs as a substitute for the lost muscles, and
taking the greatest pains to make the insertion-points of these to exactly
correspond with the insertions of the natural muscles. This was effected
by means of sheaths, imitating natural tendinous sheaths, sewed to a
glove or gaiter in which the hand or foot was encased.
175 Article “Orthopédie,” Dict. des Sciences médicales, quoted by Duchenne.

176 Traité des Bandages, 2d ed., Paris, 1837, quoted by Duchenne.

177 See chapter on “Prothetic Apparatus” in his treatise De l'Électrisation localisée.

At the present day the prothetic apparatus the most employed is that
contrived by Barwell.178 The principle is the same as Duchenne's, but the
artificial muscles are made of India-rubber, to which a small metallic chain
is adjusted, and they are attached to the limb by means of specially-
devised bands of adhesive plaster and pieces of tin bearing loops for the
insertion of the muscle. In this apparatus the artificial muscles do not
attempt to imitate the situation of the natural muscles with the precision
which Duchenne claimed for his. Barwell's own dressing for talipes valgus
consists of two rubber muscles which pass from the inner border of the
foot, one to the inner, the other to the anterior, part of a band which
encircles the leg just below the knee. For talipes calcaneus another band
is required behind the leg, passing to the heel, as in Volkmann's
apparatus, already mentioned. For talipes varus a rubber band should
pass on the outside of the foot; for equinus, one or more from the anterior
part of the leg to the sides of the anterior part of the foot.
178 A tolerably minute account of the Barwell dressing is given by Sayre, loc. cit., p. 84.

Sayre endorses Barwell's dressing as entirely adequate for the treatment

of any form of club-foot, but modifies it by substituting a ball-and-socket
shoe for the adhesive plaster which should encircle the foot. The artificial
muscles are then passed from the sides of the shoe to a padded leather
girdle encircling the leg. A straight splint, jointed opposite the ankle, runs
up from each side of the foot to this girdle, and from it two lateral upright
bars, jointed at the ankle, pass to the heel of the shoe; and from below
the joint passes forward on each side a horizontal bar reaching the point
of origin of the artificial muscles and giving attachment to them.

In equinus it is necessary to bind the heel of the foot down firmly in the
heel of the shoe; and this is accomplished by means of two chamois-
leather flaps which are attached to the inside walls of the shoe and lace
firmly across the foot.179
179 “The aim of the dressing or instrument is simply to imitate the action of the surgeon's
hand; accordingly, any apparatus combining elastic force is far superior to any fixed
appliance; and, moreover, that is to be preferred which is the most readily removable.
Shoes, therefore, are better than bandages or splints. A proper shoe must have joints
opposite the ankle and the medio-tarsal articulation; it must permit the ready application of
elastic power; and it must not so girdle the limb as to interfere with the circulation” (Sayre,
loc. cit., p. 91).