Chloroform, Ether, and the Civil War
Topics:
Anesthesia, CHLOROFORMUM
PURIFICATUM, SPIRITUS AETHERIS COMPOSITUS
From:
Military Medicine,
Feb
2004 by
Connor, J T H
The advent of general inhalation anesthesia using sulfuric ether in 1846, and
chloroform the following year, transformed military as well as civilian surgery.
Its introduction in civilian life coincided with the Mexican-American war
(1846-48), which saw ether used for the first time by American military surgeons
under combat conditions. Initially, its employment by army doctors remained
extremely limited, but by 1849 ether was officially issued by the U.S. Army. It
was during the Civil War, however, that painless surgery on the battlefield
became fully established. Interestingly, despite American doctors' extensive
experience with ether by then, chloroform became the anesthetic agent of choice
by both Union and Confederate army surgeons for the duration of the hostilities.
This decision was grounded in the faster action of chloroform and the good
record it had earned on the battlefields of the Crimean War. [1]
The ability of
chloroform to induce insensibility for extended periods was first brought to
professional notice by (later, Sir) James Young Simpson, a noted Edinburgh
obstetrician. he and local medical colleagues sought an anesthetic agent that
was superior to ether by inhaling numerous chemical compounds and then waiting
to observe their effects. When he finally tested chloroform, Simpson believed he
had discovered the ideal agent because of its effectiveness and its apparent
patient safety. Other attributes included its non-flammability, its economy, and
its relatively inoffensive odor. The comparatively easy method of administration
and speed of action also recommended it. Chloroform was slowly dropped onto a
cone comprised of a handkerchief or a piece of cotton that was placed over the
patient's mouth and nose. When things went correctly, the patient went into a
deep, peaceful slumber and became placidly oblivious to the fact that a leg was
being sawed off, for example. And things went correctly tens of thousands of
times as major surgery was undertaken painlessly-as one Victorian surgeon
expressed it, patients now had been "rendered unconscious of torture." [2]
Occasionally things turned out badly, however, when patients died in the first
few minutes of having chloroform administered; these events were usually
well-publicized in contemporary newspapers, coroners' inquests, and medical
journals. [3] As a result, even well into the Civil War era, some patients
declined the use of anesthesia, choosing instead to endure surgery while awake.
With the onset of war
in the early 1860s, notable surgeons from both the North and the South wrote
surgical manuals for military use in the field. These works show a consensus
about the use of chloroform. The critical factor for this agreement was the
overwhelmingly successful experience of British and French army surgeons during
the earlier Crimean War. But these American medical authors did not agree on
everything. Samuel Gross of Jefferson Medical College in Philadelphia believed
that anesthetics should not be used in all surgical cases, especially in
instances where soldiers were so "bewildered with shock" for it was "astonishing
what little suffering" they experienced. [4] Whereas J. Julian Chisolm of South
Carolina's Medical College believed chloroform to be "wonderful in mitigating
the suffering of the wounded." Chisolm decried those doctors brought up in
pre-anesthetic days who "moralize upon the duty of suffering" and who
"characterize the cries of the patient as music to the ear." [5]
Most surgeons agreed
however, in not recommending mechanical inhalers, preferring the tried and true
method of a hand crafted cone-shaped towel fitted lightly over the patient's
mouth and nose. (Later, Chisolm would devise his own unique inhaler to help
economize the South's use of chloroform as supplies began to run low. [6]) Dr.
John Packard, a Visiting Surgeon at the West Philadelphia Military Hospital,
also observed that chloroform worked best when administered in the open air. [7]
Finally, these doctors maintained that the operating surgeon should not have the
responsibility of administering the anesthetic, but should have the help of at
least one assistant to do so. (The technique is illustrated in the photograph.)
Reflecting the reality of surgery on the battlefield, they realized that
military surgery was not the same as its civilian counterpart. In 1863, Edward
Warren, former University of Maryland professor and then Surgeon General of
North Carolina, admonished readers that all his directions applied only where a
full complement of medical officers existed, a "rare circumstance... and a most
unfortunate one, as the history of every camp and field attests." [8]
The true test of
chloroform was its efficacy on the battlefield. Records and statistics kept by
the Army Medical Museum (founded in 1862), used to compile the massive
multi-volume Medical and Surgical History of the War of the Rebellion, attest to
the extent and utility of anesthesia in the Civil War. Over 174,000 gunshot
wounds of the extremities were reported, the majority of which were treated
without extensive surgery; however, 4,656 were treated by surgical excision and
another 29,980 by amputation. Exactly how often anesthesia was employed during
the war is not known, but Union Army surgeons at the Museum believed that a good
estimate was 80,000 cases. Certainly, detailed field notes amassed by the Museum
showed that of 8,900 cases, in which anesthetics were definitely used,
chloroform was the agent of choice- 6,784 employed chloroform (76.2%), 1,305
employed ether (14.7%), and 811 employed a combination of both chloroform and
ether (9.1%). Supporting these statistics were the individual testimonies of
field surgeons who noted that they "invariably," "universally," "always," "in
every painful operation," used chloroform. Only 37 deaths (5.4 deaths for every
thousand cases) were attributed to chloroform, of the just under 7,000 instances
in which it was the anesthetic used. [9] The experience with chloroform in the
Civil War, along with other anesthetic agents, might help put to rest apocryphal
stories of the purported widespread practice of soldiers biting on bullets, or
being overdosed with whisky during surgery. But such stories continue to linger.
Ether, Chloroform, and Morphine
anesthetics
(Note: In 1856 Edward
Robinson Squibb founded a pharmaceutical company in Brooklyn, New York,
dedicated to the production of consistently pure medicines. In 1895 Squibb
passed most of the responsibility for managing the firm to his sons, Charles and
Edward. The company became known as E.R. Squibb & Sons. So, any Squibb
products used in the Civil War will NOT have '& Sons' on the label.)
U. S. Army Hospital Department pannier label by E. R. Squibb (Not "Squibb &
Son's", which is later)
In a Civil War Squibb pannier
various anesthetics were labeled:
Chloroform was labeled:
CHLOROFORMUM PURIFICATUM. (chloroform) and packaged in twelve fluid ounces
Ether was labeled:
SPIRITUS AETHERIS COMPOSITUS. (compound spirits of ether) packaged in four
fluid ounces) or as SPIRITUS FRUMENTI. (spirits
of nitric ether) Twenty-four fluid ounces
Morphine was labeled:
LIQUOR MORPHIAE SULPHATIS. (morphine sulphate solution) Sixteen grains to
the fluid ounce, four fluid ounces)
Opium was labeled: PILLS OF CAMPHOR AND
OPIUM. Twenty dozen; PILULAE OPII. (opium pills) Sixty dozen; PULVIS IPECAC:
ET OPII. (powder of ipecac and opium) In five gram pills, thirty dozen;
TINCTURA OPII. (tincture of opium; laudanum) Six fluid ounces
Article on anesthesia during the
Civil War
Article on chloroform during the Civil War
Additional information on the Chisolm ether and
chloroform inhaler
Article on the
Inhalation of Sulphuric Ether, as reported in Boston Medical Journal, 1861
