Anesthesia in the Civil War
Terry Reimer
Originally published in 2002 in the Surgeon’s Call
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 and is one of the myths that the Museum tries to dispel.
Sulfuric ether had been discovered in Europe in the 1830’s. On October 16, 1846, William Thomas Green Morton, a dentist, exhibited the anesthetic properties of ether. With Morton holding the glass apparatus used to administer the ether, surgeon John Collins Warren removed a small tumor from the jaw of a patient. A public announcement was made on November 18, 1846, and ether was widely used within a few months. Chloroform, another anesthetic which had been discovered in 1832, was in common use soon after ether.
By the Civil War, the anesthetic qualities of chloroform and ether were well known, and anesthesia was used in approximately 95% of Civil War surgeries. The Medical and Surgical History of the Civil War estimates that an anesthetic of some form was used in no less than 80,000 Union surgical cases. There were only 254 reported cases in which no anesthetic was used.
Chloroform was the preferred anesthetic since a smaller quantity was needed and its effect was rapid. It was administered by placing the chloroform on a sponge at the top of a cone and putting the open end over the patient’s nose and mouth. Once the patient was affected the cone was removed. The average time needed for the administration of chloroform was nine minutes. Ether, or a combination of chloroform and 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. It was administered the same way as chloroform. Another drawback for using ether was that it was flammable, a dangerous matter in an era of gas and candle lighting.
The myth about “biting the bullet” may have come from the fact that 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 and 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.
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. Delicate operations, such as head and neck wounds or plastic surgery, were sometimes done without anesthetic for unknown reasons. In one documented case of a debilitated soldier with a bad hip wound, an amputation at the hip was attempted without anesthetic because of the condition of the patient, who was given morphine instead. Lastly, one soldier with a shoulder wound refused any type of anesthetic, leaving the surgeon little choice but to proceed without it.
By the Civil War, surgeons fully understood the benefits of using general anesthesia for major operations. One of the goals of this Museum is to educate the public on this often- misunderstood aspect of Civil War medicine.
UPDATE: The myth of bitten bullets if further perpetuated by bullets with teeth marks found on battlefields. While the teeth marks may appear human, they are actually from pigs.
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)
Civil War Medicine: Challenges and Triumphs; Alfred Jay Bollet, Galen Press, 2002