During surgical procedures in the first half of the 1800s, patients yelled and moaned in excruciating pain as they watched surgeons remove tumors from their bodies and take saws to their limbs. The sounds of pain were terrible and heartbreaking.
But on that day in 1846, Boston dentist William Thomas Green Morton administered diethyl-ether vapors to patient Gilbert Abbott in front of a crowd gathered at the Ether Dome. He used a newly created apparatus — a tube and glass globe with valves, flaps and springs. When Mr. Morton placed the mouthpiece in Mr. Abbott’s lips, he told him to breathe deeply and slowly. In three to four minutes, Mr. Abbott became insensible and had fallen into a sleeplike state.
Mr. Morton turned to Boston surgeon John Collins Warren, MD, and told him the patient was ready. Dr. Warren raised his scalpel and made an incision in Mr. Abbott’s neck. To the surgeon and audience’s astonishment, the patient did not scream.
“Gentleman,” the flinty surgeon-in-chief stated, “this is no humbug.”
Tracing the Roots of Critical Care at Mass General
The Department of Anesthesia, Critical Care and Pain Medicine at Mass General traces its roots back to that October day when the first public demonstration of medical ether occurred.
Critical care as a medical discipline began in the United States in the mid-1950s during the polio epidemic when polio patients were dying of paralytic poliomyelitis, a type of respiratory failure.
In 1961, Mass General created the first intensive care unit (ICU) in New England.
Critical care and anesthesia have had many advances in recent years, but perhaps the H1N1 epidemic best illustrates how quickly and efficiently the Mass General multidisciplinary intensive care teams can handle a crisis.
During the H1N1 outbreak in 2009, Mass General had a direct line to the Centers for Disease Control and Prevention in Atlanta, the government entity managing the epidemic in the United States. Mass General physicians were able to also coordinate with colleagues as far away as Australia, which had been hit with the H1N1 epidemic first, in order to collect information about what their colleagues were observing in patients.
Then, Mass General providers established treatment guidelines and forecast the expected impact on hospital beds. They also mapped out worst-case scenarios and what they would need to do to handle them. They shared their treatment guidelines with other hospitals.
Sharpening the Focus on Bacteria
Because state laboratories were overwhelmed with requests for H1N1 testing, Mass General sought an emergency-use exemption from the U.S. Food and Drug Administration. The exemption allowed the hospital to run its own tests. Tests were run twice daily to determine which patients had H1N1. With the most up-to-date information, patients with the highly contagious virus could be isolated.
MGH also houses the only established center for an experimental procedure called Extracorporeal Membrane Oxygenation (ECMO), which was used to support the breathing of patients with damaged lungs resulting from the H1N1 infection. ECMO works by using a machine outside of the body, called an oxygenator, to pull blood from the patient, remove the carbon dioxide and return the blood to the patient. As Mass General pushes ahead in critical care, researchers and physicians are turning their attention to gaining a better understanding of the bacteria in diseases such as pneumonia, which send many people to the intensive care unit. They are also looking into using a person’s individual genes to guide treatment and growing organs outside of the human body.
For the department inspired by the country’s first public demonstration of ether, the future should be just as exciting as the past.
If you would like to learn about ways to support the intensive care units at Mass General, please contact us.