Friday, February 25, 2011

First 100 medical and surgical cases

MGH physicians research early MGH medical records

In the nearly two centuries since the MGH received its first medical patient, a saddler with syphilis, and its first surgical patient, a sailor with a severe case of hemorrhoids, the hospital has been visited by millions of patients from around the world seeking leading-edge treatment and compassionate care. As part of the commemoration of the MGH’s 200th anniversary, two members of the MGH History Committee -- Morton Swartz, MD, former chief of the Infectious Disease Unit, and Stephen Dretler, MD, emeritus director of the MGH Kidney Stone Center -- researched the first 100 medical and surgical cases at the hospital and compiled their notes for the hospital community.


The physicians logged many hours searching the original case records of the earliest patients, who were seen beginning in 1821, ten years after the MGH charter was signed on Feb. 25, 1811.

Among the more interesting cases Swartz uncovered had to do with the first medical patient. The 30-year-old saddler was admitted on Sept. 3, 1821, with secondary syphilis. Because he was the first patient at the hospital, he received much attention from caregivers. His treatment -- the notes of which span more than 20 pages in the first volume of MGH medical records -- included twice-daily doses of mercury, boiled milk and lime water along with a carrot poultice. Eight months after he was admitted, the saddler died at the MGH, most likely from mercury poisoning. The records show that his wife -- in order to help pay for his care -- worked at the hospital as an untrained nurse.

Written histories: Volume one of the first medical and surgical records

“Aside from the general way of treating patients back then, other interesting facts were the breakdown of the diagnoses of these early patients,” says Swartz. “Thirty-five percent of the admissions were related to cardiac disease. Next, there were patients who were admitted due to ailments related to pulmonary, nervous system, vascular and metabolic disorders.”

Dretler, who for six months spent most Wednesday afternoons researching the MGH archives, also found intriguing information about the first 100 surgical cases.

“The majority of surgical cases the hospital saw in the early 1800s were orthopædic trauma cases – such as leg and ankle fractures,” explains Dretler, who says that the most difficult part of his research was deciphering the 19th century handwriting, which had many flourishes and abbreviations. “In addition to the handwriting being difficult to read, the language and terminology were quite different. Researching the project was tedious, but the information was really very interesting.”

He adds, “Because the first surgeries occurred before the general use of anesthesia, many patients endured tremendous pain. Also, there was little to no understanding of infection control, so there was a lot of infection back then. And there was no pathology, so if they surgically removed something, they didn’t know what it was.”

The most dramatic case, Dretler says, was a cataract surgery, during which MGH surgeons used a small device that spread and held the eyelids open. They then used a “couching needle,” which was put into the eye to break up the cloudy lens and used it to push the broken-up lens back into the vitreous. Dretler notes that many of the medical records of these procedures included a common note that “the patient tolerated the procedure with fortitude.” He also says patients often would later have the procedure performed on the other eye.

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