Leech bleedings and weather reports: Inside the first issue of the New England Journal of Medicine

John Collins Warren (August 1, 1778 - May 4, 1856), of Boston, was one of the founders of Massachusetts General Hospital and also its first visiting surgeon. Via Boston Globe archives.
John Collins Warren (August 1, 1778 - May 4, 1856), of Boston, was one of the founders of Massachusetts General Hospital and also its first visiting surgeon. Via Boston Globe archives.

Two hundred three years ago, to put it kindly, Boston wasn’t exactly the global powerhouse of medical innovation it is today. As a matter of fact, if you wanted to be blunt about it, you could quote the current editor of the New England Journal of Medicine and call it “a medical backwater” — at least compared to Europe.

Angina by WarrenBut within the United States proper, the city still had a few things going for it—a medical school at Harvard and a charter for a brand new general hospital—both national rarities at the time. It also had two of the country’s leading medical practitioners: James Jackson and John Collins Warren.

Despite this and in contrast to competitor cities like New York and Philadelphia, Boston did not have any sort of trade journal collecting and disseminating medical information to and from the area’s clinicians. And so, in the fall of the 1811, Jackson and Warren put out a call for papers in the Boston Patriot with the plan of establishing their very own New England Journal of Medicine and Surgery and the Collateral Branches of Science (rebranded in 1928 as the New England Journal of Medicine).

The first issue appeared in January 1812, followed by three more in April, July, and October. The pages of that inaugural volume contained everything from clinical and post-mortem descriptions of angina patients, instructions for cold bathing (“The first rule then to be observed in taking the cold bath is, not to go into the water when cold“), guidelines on leech breeding, and a particularly grisly cataract surgery reported on by Warren himself and involving knives, thumbs, forceps, and a fine hook. (“No inconvenience followed, till about two months after the operation, when a slight inflammation was brought on by some accident. Two or three bleedings removed this disorder”).

And then, of course, there was  the local weather report. Laugh (and cringe) if you must, but actually, these topics, even the weather, were not so backwards as you might think, points out Allan Brandt, 200 years later in his introduction to the Journal’s bicentennial celebration:

“The first decades of the Journal’s history reflected the intensive concern with the epidemics affecting New England and the new nation, and it was not unusual during the early years for authors to direct attention to the environment as a critical variable in the production of disease. …Such articles may appear both quaint and humorous from our contemporary scientific perch, but they reveal a serious commitment to understanding more fully the vagaries of epidemic disease that could devastate town and country in short order.

This sort of careful and critical thinking persisted and grew through the years as medical caregivers practiced their way through evolutions in knowledge, ethics, and technique. The Journal eventually marked many firsts, more than a few that took place in Boston itself. There was the demonstration of ether anesthesia during a surgery at MGH, for example, and the successful remission of childhood leukemia at Children’s. In the end, it has outlived almost all of its competitors of the era, rising in tandem with its city of origin to become one of the most influential medical journals around today, founded in what has similarly become one of the most important medical communities in the world.

Not bad for a modest little doctor’s journal that aimed simply to spread a little common knowledge to the locals.