Anesthesia in the Civil War

When most people think of Civil War surgery they envision a poor soldier being forcibly held down while his arm or leg is amputated without the benefit of anesthesia. Almost invariably, they picture him “biting the bullet” to help relieve the pain. This Hollywood concept of Civil War surgery is far from accurate.

Anesthesia was used in 95% of Civil War surgeries.

Sulfuric ether had been discovered in Europe in the 1830’s and was first used as an anesthetic by William Morton in 1846. After a successful public demonstration it became widely used in surgery. Chloroform, which had been discovered in 1832, was soon in common use as well.

By the Civil War, the anesthetic qualities of chloroform and ether were well known and widely used. Chloroform was the preferred anesthetic since a smaller quantity was needed and its effect was rapid.

Chloroform was administered by placing the anesthetic on a sponge at the top of a cone and putting the open end over the patient’s nose and mouth. It was administered gradually to avoid shock. Once the patient was affected the cone was removed. The average time needed for the administration of chloroform was nine minutes.

Ether was used less frequently since more of the substance was needed to produce the desired effect and it took an average of seventeen minutes to work. The best method of administration was to use a folded towel or bell-shaped sponge which was large enough to cover the nose and mouth. This was then soaked with the anesthetic. Another drawback for using ether was that it was flammable, a dangerous matter in an era of gas and candle lighting.

Both ether and chloroform were manufactured in large medical laboratories run by the armies on both sides. Some private laboratories, like Squibb’s, contracted with the Union Army to produce drugs and developed an improved way to distill ether.

Ether is made by distilling a mix of ethanol and sulphuric acid. It is highly explosive, so care must be taken both when manufacturing and administering the drug. Chloroform is an organic compound and is usually created by the chlorination of ester alcohol or methane. It is much more stable than ether and can safely be used around open flame.

Only a low dose of anesthetic was used during the Civil War, just enough to make the patient insensitive to pain.  Surgeons worked quickly and could complete a major operation in a matter of minutes. Many men moaned and moved about due to the agitating effects of a light dose of anesthetic.Some had to be held down by assistants, but they were unconscious and could not feel pain. Outside observers may have assumed that the men were being operated upon with no anesthetic, not understanding that the groans and thrashing movements were caused by the chloroform or ether. These observations, combined with Civil War bullets found with pig’s teeth marks, have helped lend credence to the myth of “biting the bullet.”

In the rare cases where anesthetics were not used, a number of reasons were reported.  Lack of supply, especially for the Confederates due to the blockade, is one of the most common. Another is that some gravely wounded men were already unconscious and did not need an anesthetic.

A recent review of the primary sources from the Civil War—soldiers’, surgeons’ and nurses’ diaries, plus medical manuals—failed to turn up any contemporary references to biting the bullet, especially during surgery. The surgical manuals do not advocate placing anything in the patient’s mouth. Placing a bullet between the teeth of a prone man who is likely to scream in pain is not the smartest thing to do.

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Additional Resources

Primary Sources

• The Medical and Surgical History of the Civil War, prepared by Surgeon General Joseph K. Barnes, 1870; reprinted 1991, Broadfoot Publishing Co., Wilmington, N.C. (originally titled Medical and Surgical History of the War of the Rebellion 1861-1865)
• A Manual of Military Surgery for the Use of Surgeons in the Confederate States Army, with Explanatory Plates of all Useful Operations; J. Julian Chisolm, M.D., Evans and Cogswell, 1864; reprinted 1983, Morningside House, Dayton, Ohio
• A Manual of Military Surgery Prepared for the Use of the Confederate States Army; Samuel Preston Moore, 1863; reprinted 1989, Norman Publishing Co., San Francisco
• An Epitome of Practical Surgery; Edward Warren, 1863; reprinted 1989, Norman Publishing Co., San Francisco
• Hand-Book of Surgical Operations; Stephen Smith, 1862; reprinted 1990, Norman Publishing Co., San Francisco
• Notes and Observations on Army Surgery; F. Formento; bound with A Treatise on Gun-Shot Wounds; Moritz Schuppert, 1863 (Confederate); reprinted 1990, Norman Publishing Co., San Francisco
• A Surgeon’s Civil War: Letters and Diaries of Daniel M. Holt; edited by James M. Greiner, Janet L. Coryell, and James R. Smither, Kent University Press, 1994
• I Acted From Principle: The Civil War Diary of Dr. William M. McPheeters, Cynthia Dehaven Pitcock and Bill J. Gurley, eds., University of Arkansas Press, 2002

 Secondary Sources

• Ether Day; Julie M. Fenster, Harper Collins Publishers, New York, 2001
• For Fear of Pain: British Surgery 1790-1850; Peter Stanley, Rodopi, 2003
• Civil War Medicine: Challenges and Triumphs; Alfred Jay Bollet, Galen Press, Tucson, AZ, 2002
• Medicines for the Union Army: The United States Army Laboratories During the Civil War; George Winston Smith, American Institute of the History of Pharmacy, Madison, Wisconsin, 1962; reprinted 2001, Pharmaceutical Products Press
• Civil War Pharmacy; Michael A. Flannery, Pharmaceutical Products Press, 2004
• On Edward R. Squibb: https://www.uab.edu/reynolds/cwfigs/squibb

About the Author

Terry Reimer is the Director of Research the National Museum of Civil War Medicine in Frederick, MD. Prior work includes experience in historical archaeology and research, specializing in 17th, 18th and 19th century American sites. Reimer is the author of two books on Civil War medical history, including One Vast Hospital.  She also co-author of two more, including Caleb Dorsey Baer and Bad Doctors.