Wednesday, August 10, 2011

Civil War Anesthesia

Among the Civil War myths that have evolved are stories of soldiers biting bullets in order to bear surgical pain; of men crudely anesthetized by drinking large amounts of liquor. In truth, both Northern and Southern surgeries were almost always performed on patients rendered unconscious by ether or chloroform.
These anesthetics were usually administered by a soaked towel or handkerchief placed over the face. Late in the war, Confederate surgeon Dr. Julian Chisolm developed a more accurate method of dispensing anesthesia, known as the “Chisolm Inhaler”.

Mid-nineteenth century dentists had begun to embrace the use of anesthesia, although American physicians and surgeons were not as familiar with it. President Lincoln was evidently acquainted with chloroform, bringing his own supply to an 1862 dental appointment.

Anesthesia was given to keep a patient insensible during his surgery. At the time, a standard dose of anesthesia gave surgeons an estimated window of nine minutes to work. Soldiers frequently woke up at the end of the operation not in a calm recovery room, but still on the operating table, surrounded by the gore of previous operations and the sounds of other surgeries.

Although anesthesia was almost always, as a rule, used during Civil War surgeries, images of soldiers thrashing in pain on operating tables were widely circulated. A phenomenon now known as “second-stage anesthesia” was noted by many wartime surgeons. In this interim state of consciousness, the patient is restless and active before the body reaches complete unconsciousness. Surgery was often performed outdoors, where passing soldiers may have witnessed the writhing and moaning and assumed that no anesthesia was being used.
Ether was indispensible for surgery, but because of its highly flammable nature, it was also dangerous. Nighttime surgery was lit by candles, posing an extreme hazard to both doctor and patient.

On the battlefield, chloroform was preferred over ether because it had less bulk, more rapid induction, and was non-flammable. But chloroform’s effect could be unpredictable, and sometimes rapid death followed its use.
William Thomas Green Morton was a dentist from Massachusetts and a pioneer in the use of ether as an anesthetic agent. Early in the Civil War he volunteered his skill, and administered pain-killing anesthesia to hundreds of wounded troops.

The Civil War prompted wider use of these anesthetic agents, which had actually been available in American for more than a decade. The uses of ether as an anesthetic had been acknowledged in a report on surgery to the College of Physicians of Philadelphia, 15 years before the start of the war.


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