The Genealogy Of Mass General

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To their credit, the surgeons and physicians associated with the hospital were often skeptical of the practices known, aptly, as “heroic medicine” (the heroism, of course, was the patient’s). In the tough-minded spirit of selfcriticism that so often typified New Englanders, Jacob Bigelow, physician at Mass General from 1836 to 1855, conceded that medicine’s claim to honor seemed feeble indeed. Shortly before joining the hospital’s staff, Bigelow gave an influential address in which he admitted to the “humiliating conclusion, that while other sciences have been carried forward, within our own time and almost under our own eyes, to a degree of unprecedented advancement, Medicine, in regard to some of its professed and most important objects, is still an ineffectual speculation.” Over twenty years later he was still emphatic: the “unbiased opinion of most medical men of sound judgment and long experience” was that “the amount of death and disaster in the world would be less, if all disease were left to itself.…”

Two years later Oliver Wendell Holmes of the Harvard Medical School put the matter somewhat more pithily: “If the whole materia medica [that is, drugs and treatments], as now used , could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.” Responding later to outraged practitioners who heard his remarks, he observed: “One thing is certain. A loud outcry on a slight touch reveals the weak spot in a profession, as well as in a patient.”

Twenty-five years after it opened, however, the hospital made a very real and enduring contribution to medical care, in large part by exploiting its social influence. In 1846 a somewhat too enterprising Boston dentist, William Morton, persuaded John Collins Warren, still visiting surgeon at the hospital he helped found, to perform surgery on a patient exposed to the vapors of a substance that Morton called letheon . On October 16 the demonstration was carried out. A patient was successfully anesthetized with the vapors of ether (as anyone with a nose could tell), and a large tumor was painlessly removed from his neck. Warren is supposed to have looked up from his work and said to the assembled onlookers, “Gentlemen, this is no humbug”; and on that day the era of surgical anesthesia began.

Each year since 1903, the hospital has commemorated Ether Day on October 16, though it is now mainly an occasion for the trustees to give souvenir pins to long-term employees and deliver speeches to a small audience of staff members and their families. The amphitheater where the operation was performed, high under the dome of the Bulfinch Building, is called the Ether Dome, and many of the hospital’s meetings are held there.

In the general rejoicing over the introduction of painfree surgery, an important historical point about ether anesthesia at Mass General can be lost; the hospital itself had nothing to do with the discovery. Its surgeons, however, were clear-sighted enough to recognize a good thing and then use their influence to popularize it. The role the hospital played—entirely consistent with its character at the time—was to give the stamp of social approval to an innovation brought by an outsider.

The availability of anesthesia gradually increased the amount of surgery that was performed, but it did not improve success rates. The problem of infection continued, and another two decades would elapse before Joseph Lister published his first paper, in 1867, on the use of antiseptics to prevent wound infections. Unlike the use of anesthesia, which was rapidly adopted, sterile operating procedure came into use rather slowly at Mass General, and “capital” surgery remained out of favor at the hospital.

An aggressive Bostonian, Dr. John Homans, had begun performing abdominal surgery by the early 1870s, but he did his operations at a small private hospital on Beacon Hill. When he joined the staff of Mass General, the trustees explicity denied him permission to perform such surgery in their hospital, mainly because they were fearful of infection. Another surgeon at Mass General, Arthur Tracy Cabot, appears to have been the first staff member to cut into an abdomen under the hospital’s auspices. This was in 1874. But for the purpose he used rented rooms in a house near the hospital rather than run the risk of “hospitalism.” Only in 1884 did Cabot perform his first abdominal operations within the walls of the hospital.

Two years later, in 1886, Mass General made what was probably its first authentic and important contribution to modern medical research. That year Reginald H. Fitz coined the term appendicitis and gave an analysis of the disease that paved the way for proper diagnosis and successful surgical treatment.