The New England Journal of Medicine’s most important article

November 19, 2012

The New England Journal of Medicine is the oldest continuously publishing medical journal in the world, and easily among the most influential. It published much of the research that guides our medical decision-making today, including the finding that aspirin may help prevent heart attacks and how to best treat strokes.

The journal remains a big force in health policy: Earlier this year, NEJM published some of the only research we have finding a correlation between Medicaid coverage and longer life expectancy.

That latest news made the journal's subsequent task all the more challenging: NEJM asked its readers, largely doctors, to go back through 200 years of archives and decide what counts as its most important article. 

Even though there were lots of options to choose from, the votes settled on a solid favorite: the 1846 classic, "Insensibility During Surgical Operations Produced by Inhalations."

Translation: The invention of ether anesthesia.

"It has long been an important problem in medical science to devise some method of mitigating the pain of surgical operations," author Henry Jacob Bigelow, a surgeon at Massachusetts General Hospital, began in the paper. He then announced that "an efficient agent for this purpose has at length been discovered."

The article then goes on to detail "a number of experiments" that Bigelow undertook on his patients. It wasn't exactly a flawless process. "It seemed probable that the ether might be so long inhaled as to produce excessive inebriation and insensibility," he wrote of tinkering with the anesthesia doses. "But in several experiments the exhilaration was so considerable that the subject became uncontrollable, and refused lo inspire through the apparatus." 

Anesthesia has since, as we know, hugely changed how doctors practice medicine. You can read the first page of the article below and the full text over at the New England Journal of Medicine.  

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Brad Plumer | November 19, 2012