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Massachusetts General Hospital at 200

A great institution rises and, with it, the healing arts

Boston’s first general hospital did what it could for the poor; today it brings cutting edge care to the city, and world

By Liz Kowalczyk
Globe Staff / February 26, 2011

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When Massachusetts General Hospital opened in 1821, most patients were required to apply in writing for admission. They could be turned away for “bad morals’’ — and discharged for spitting, drinking, smoking, or swearing. Patients who followed the rules stayed for two months on average at an all-inclusive daily rate of 43 cents.

They endured hemorrhoid and cataract surgery and amputations without anesthesia — assistants held them down, and sometimes they got opium and brandy for pain. Patients seeking treatment of broken legs or arms died as often as they went home.

Nearly 200 years later, patients still can’t smoke, but that’s about the only similarity.

The average stay for patients not having surgery is less than five days, the average age, about 64 — up from 30 when the hospital opened. Patients are asleep or fully numb for operations, and fixing broken bones is low-risk and routine. The average daily rate: $3,200, before the discount given to insurers, and not including extras like physicians’ fees.

Even taking into account inflation, the cost of spending a day at Mass. General is more than 400 times higher now than it was two centuries ago. Perhaps that’s the price of medical progress.

This portrait of the dramatic changes and advances in care emerged from research by two Mass. General doctors, who studied the earliest patients as part of the hospital’s celebration of this milestone — the Legislature created Mass. General on Feb. 25, 1811, but it didn’t open to patients until a decade later.

Mass. General executives and caregivers and legislative leaders marked the hospital’s 200th anniversary at the State House yesterday with a soliloquy by a John Adams impersonator, a signing of a “symbolic renewed version’’ of the hospital’s charter, and 19th century food and drinks.

Following institutions in Pennsylvania and New York, Mass. General was the third general hospital established in the United States. The hospital, which opened with 60 beds mainly so the poor would have a place to get treated, admitted its first patient on Sept. 1, 1821 — a 30-year-old saddler with syphilis, who, the records pointedly note, contracted the disease not in Boston but in New York City. After months of treatment with mercury, boiled milk and lime water, and a carrot poultice, he died at the hospital nine months later — most likely from mercury poisoning.

“People were doing the very best they could; they were applying what they thought were modern methods,’’ said Dr. Paul Russell, a transplant surgeon and chairman of the hospital’s history committee.

He’s the one who asked Dr. Stephen Dretler to research Mass. General’s first 100 surgery patients and Dr. Morton Swartz to chronicle the first 100 medicine patients. “I wanted to show how different medicine had become,’’ he said. “We really have come a long way.’’

A sampling of the cases will be featured in a museum Mass. General is building next to the hospital on Cambridge Street in Boston. It is scheduled to be open later this year and will be named after Russell.

Some of the treatments — ineffective ones like leeches and carrot packs and harmful remedies like mercury, and operations on patients who were fully awake — might seem barbaric, but medical historian Amalie Kass, a lecturer at Harvard Medical School, said “that’s all there was.’’

“It was very rudimentary care,’’ she said. “They didn’t understand what caused infection or what caused disease. They didn’t have X-rays. They didn’t have antibiotics.’’

Largely because of antibiotics, syphilis is rare today in the United States, as is dying from an infection around a broken bone.

Swartz, who compared the first 100 medicine cases with 100 medicine cases in 2007, found that half of the earliest patients came to the hospital for infections, while they accounted for just 13 percent of cases four years ago. The most common diagnosis in 2007, affecting 35 percent of all patients, was heart disease — a condition rarely treated in the early 1800s.

Mass. General was built using donations from wealthy residents, who preferred to receive medical care in their homes unless they required surgery with special equipment, Kass said. The poor needed a place where they could get treatment and rest without worrying about paying for it, so the hospital’s “free beds’’ were subsidized, often by an employer who had the right to then use the bed for a servant, according to Webster Bull, who wrote a history of the hospital with his daughter, Martha Bull, that is being published in May.

The asylum for the mentally ill, which was a division of Mass. General and later became McLean Hospital, “was the cash cow’’ of the organization, Bull said, because the wealthy were more than willing to send relatives there.

Doctors were not paid; they earned money in their private practices and from teaching.

Dretler did his research on Wednesday afternoons for six months. He would remove his watch — to prevent it from damaging delicate pages — and pore through the giant ledger books where doctors recorded early cases. The work was slow, he said, because records were written in sometimes indecipherable flourished script.

He never saw the word “cancer,’’ he said; there were no tests that permitted that diagnosis though many patients were admitted with symptoms that could have been cancer. The biggest difference was lack of anesthesia, which was first demonstrated at Mass. General in 1846. They did give sedatives and pain killers, but they were not very effective. “It was like someone being drunk’’ during surgery, he said.

Dretler, a urological surgeon, said the description of one operation in particular — cataract surgery — made him squirm.

Four people held down the patient, while the surgeon spread open the patient’s eyelids with an instrument resembling an eyelash curler. The surgeon inserted a “couching needle’’ with notches on it through the pupil and moved it back and forth to break up the cataracts.

To remove a bladder stone — the second surgical case at the hospital — helpers held the patient’s legs apart while a surgeon drove a knife through the prostate and into the bladder. He then pushed forceps through the hole and grabbed the stone.

“The things they tolerated are unheard of by us,’’ said Dretler, who noted that records rarely contained any mention of patient suffering. “In the 19th century, it was thought no pain, no gain.’’

Today, patients with cataracts get local anesthesia, a tiny slit is made in the cornea, the clouded lens is popped out, and a new lens is slid in, he said. Patients with stones are put to sleep and a fine instrument with a laser is threaded through the urethra to dissolve the stone.

They often go home the same day, Dretler said.

Liz Kowalczyk can be reached at kowalczyk@globe.com.