Resuscitation and the origins of intensive care/critical care medicine.

Abstract

Intensive care medicine (ICM) has been an independent speciality in hospital practice since its foundation in late 1953 at the Kommune Hospital, Copenhagen. The person generally recognised for its inauguration was Dr Bjorn Ibsen, an anaesthetist in Copenhagen at that time. Denmark had suffered a severe epidemic of poliomyelitis, 1952-1953, in which treatment in Copenhagen of those seriously ill from it was conducted in its Blegdams Hospital. Ibsen first attended there following the epidemic's earlier disasterous time, July-August 1952, in shich 27 of 31 ill patients afflicted with poliomyelitis complications perished, despite the best efforts at that time of the Blegdams doctors. On 27th August Dr Ibsen demonstrated with a newly admitted, seriously ill patient, an anaethetist's way of compensating for impaired ventilatory function, 'without machinery'. After an introduction briefly outlining steps in resuscitation prior to the late nineteenth century, two major themes develop the presentation of the thesis. The first considers three innovators, Drs Joseph O'Dwyer, George Fell and William Northrup, selected as pioneers of fundamental treatment modes of ICM, which were necessary in the first instance for ensuring through patency of the airway and adequacy of ventilation. The achievements of these doctors and of others such as surgeon Rudolph Matas, have, with passing of years, become less remembered for their contributions to ICM. It is appropriate to honour pioneers of such significance in the history and development of our specialty. The persistence of negative pressure ventilation (NPV) in treatment through the middle-1900s is assessed to include its undoubted assistance in treatment of the ventilatory deficiency in acute poliomyelitis, although its relative success did hold back the introduction of positive pressure ventilators. A late-1930s Australasian outbreak of poliomyelitis is considered for the usefulness of NPV respirators, as well as for the drawbacks. The claims of early ICM as a treatment mode in barbiturate intoxication in Scandinavia is examined. The second theme that is developed concerns the Danish polio epidemic, 19521953, with special consideration for Dr Bjorn Ibsen's role, particularly on Auguste 27th 1952. Various aspects of articles written on the epidemic are examined to try to enable correct documentation of facts; while the case for Ibsen's unit at the Kommune Hospital being considered the true 'first intensive care unit in the world' is debated.