The first intensive care unit was born from anaesthesia and a polio epidemic
In 1953 a polio outbreak in Copenhagen left many patients unable to breathe for weeks. Anaesthetist Bjorn Aage Ibsen took ventilation, a technique used briefly during operations, and kept it going for as long as patients needed. The result was the world's first intensive care unit, and a specialty that grew far beyond the operating theatre.
Pain control during surgery is ancient, from acupuncture and bloodletting to mandrake, opium and alcohol. The modern story is usually dated to 16 October 1846, later called Ether Day, when the dentist William Morton used an inhaler of his own design to put a patient under with diethyl ether at Massachusetts General Hospital while a neck tumour was removed. The surgeon, John Warren, reportedly told onlookers the demonstration was no humbug, though that account is disputed.
The name has a history too. Dioscorides had used a Greek word meaning without sensation for the numbness that mandrake produced. At first the new procedure was simply called etherization, since ether was the only agent known to work; after Morton's display, Oliver Wendell Holmes Sr. wrote to him proposing anesthesia instead. Cocaine, isolated in the mid-nineteenth century, opened the way to local numbing, and twentieth-century drugs that paralyse muscles let doctors breathe for patients with machines.
That ability to take over a patient's physiology is what spawned critical care. Today the specialty covers the whole period around an operation: spotting high-risk patients beforehand, watching the surgery closely, and speeding recovery afterwards. Anaesthetists staff cardiac arrest teams, air ambulances and long-distance transfers of critically ill patients, and pain medicine grew out of their skill with nerve blocks. In the Franco-German model of emergency care a physician, often an anaesthetist, goes to the patient; in the Anglo-American model the patient is rushed to hospital by non-physicians.
Even the job title varies. North Americans say anesthesiologist and reserve anesthetist for non-physicians such as nurse anesthetists, while in Britain, Australia and South Africa an anaesthetist is always a doctor. A US study of 39,910 medical students found only 0.7 percent kept an interest in the field from entry to graduation, and women were less likely than men to show early interest.
Source: Anesthesiology
