The most significant advance in medicine?

This year, readers of the New England Journal of Medicine were asked to vote on the most important article published over the last 200 years. The winning paper was the ground-breaking report written in 1846 by Henry Jacob Bigelow entitled 'Insensibility during Surgical Operations Produced by Inhalation.'  It offers a fascinating insight into the first uses of ether. The paper begins:

It has long been an important problem in medical science to devise some method of mitigating the pain of surgical operations. An efficient agent for this purpose has at length been discovered. A patient has been rendered completely insensible during an amputation of the thigh, regaining consciousness after a short interval. Other severe operations have been performed without the knowledge of the patients. So remarkable an occurrence will, it is believed, render the following details relating to the history and character of the process, not uninteresting. On the 16th of Oct., 1846, an operation was performed at the hospital, upon a patient who had inhaled a preparation administered by Dr Morton, a dentist of this city, with the alleged intention of producing insensibility to pain.

It then goes on to describe a series of cases where ether was used, with varying degrees of success, and it offers insights into the risks and dangers, clinical uses and commercial implications of this new technique.  It also describes the processes that were used for resuscitation during a prolonged operation on a young man.

.... Thirty-five minutes had now elapsed,  when I found the pulse suddenly diminishing in force, so much so, that I suggested the propriety of desisting. The pulse continued decreasing in force, and from 120 had fallen to 96. The respiration was very slow, the hands cold, and the patient insensible. Attention was now of course directed to the return of respiration and circulation. Gold affusions, as directed for poisoning with alcohol, were applied to the head, the ears were syringed, and ammonia presented to the nostrils and administered internally. For fifteen minutes the symptoms remained stationary, when it was proposed to use active exercise, as in a case of narcotism from opium. Being lifted to his feet, the patient soon made an effort to move his limbs, and the pulse became more full, bul again decreased in the sitting posture, and it was only after being compelled to walk during half an hour that the patient was able to lift his head. Complete consciousness returned only at the expiration of an hour. In this case the blood was flowing from the head, and rendered additional loss of blood unnecessary. Indeed the probable hemorrhage was previously relied on as salutary in its tendency.

The paper was a landmark in the history of medicine, and will of interest to many anaesthetists and their colleagues. Bigelow's paper is now available to read at http://www.nejm.org/doi/full/10.1056/NEJM184611180351601.

23 November 2012

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