Unhappy with today's health care? Think of what it was like to be sick 200 years ago.
No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. If you needed surgery, you got a few shots of whiskey and a bullet to bite.
Into this medical dark age, two Boston doctors brought a beacon of light. They started what is now the New England Journal of Medicine with the idea that science should guide care — not whoever argued loudest or had the most persuasive theory.
The first 100 copies in January 1812 were delivered by horseback. Today, 2 million people read the journal online every month. It is the oldest continuously publishing medical journal in the world, and it has touched lives in more ways than you may know. Some examples:
Stroke victims now get clot-busting medicine, not dark rooms to ride out their brain trauma, because a 1995 study in the journal proved its benefit.
Heart attack patients have arteries unclogged without surgery, then go home on medicines that studies in the journal showed could prevent future attacks.
Women with early stage breast cancer can have just the lump removed followed by radiation instead of losing the whole breast, thanks to a 1985 study that found the lesser surgery just as good.
Bone marrow and organ transplants — radical ideas when first tried half a century ago — are now routine. Even face transplants are becoming more common: three were described in last week's issue.
Rehydration is now recognized as the main treatment for many diarrheal diseases. A journal article warned against bloodletting in 1832 as cholera ravaged New York City.
People no longer suffer surgery without anesthesia, a field that grew from Henry Jacob Bigelow's 1846 report on the first successful use of inhaled ether.
Medicine is more ethical, and study participants have more protections, because of a 1966 report in the journal about researchers failing to get informed consent. Another top journal had rejected the article as too controversial.
The New England Journal started decades before the American Medical Association was founded in 1847 and is widely credited with promoting evidence-based care.
"It has been very good for society," said Pat Thibodeau, head librarian and associate dean for the Medical Center Library at Duke University. "When I go in, I'm hoping my doctor has read the New England Journal of Medicine or something similar and is following that information."
"It's the cream of the crop," said Dr. Barron Lerner, a Columbia University physician and medical historian.
"They get the best research submitted to them, and they do an extremely good job of peer reviewing" to make sure it is solid, he said.
That's what Boston surgeon John Collins Warren and James Jackson, who helped found Massachusetts General Hospital, hoped for the journal, which is now published weekly. It got its current name in 1928, seven years after it was bought by the Massachusetts Medical Society.
Warren's father, John Warren, surgeon to George Washington's troops, wrote the first article, on chest pain. Doctors had been debating whether it was caused by plaque — "the cement that builds up in arteries" — or blood clots, said Dr. Jeffrey Drazen, the journal's editor-in-chief since 2000. Both proved correct — the "cement" fractures and allows a clot to form that blocks an artery, he said.
Heart care has been a journal specialty, and two prominent doctors — Elizabeth Nabel and Eugene Braunwald of Brigham and Women's Hospital — trace its evolution in this week's issue. Nabel is former director of the National Heart, Lung and Blood Institute and now is president of the Boston hospital.
They describe the first human cardiac catheterization — now a common diagnostic procedure — that Werner Forssman performed on himself in 1929. Under local anesthesia, he put a catheter into his arm and maneuvered it into his own heart.