kyle.dalton
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- Oct 3, 2019
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- Frederick, MD
A while back I wrote up a paper (now published as a short series of blog posts) to help guide us in our interpretation of the use of anesthesia during the Civil War.
Throughout that research and over the year since then, I've been collecting whatever anecdotes or reports I could find regarding a lack of anesthesia.
Bellard, Alfred, “Drawing of a Civil War Leg Amputation from the Diary of Alfred Bellard, 1860s,” Civil War In Minnesota Lives
As has been stated many times (on this forum and elsewhere) it was incredibly rare that any surgeon would dare attempt a major operation without general anesthesia on hand. And for the United States forces, they never had to. The Medical and Surgical History of the War of the Rebellion showed that roughly 99.68% of surgeries conducted by United States surgeons were done with some form of general anesthesia (chloroform, ether, or a combination of the two), and attributes the minute number of cases where it was done without to misguided objection by the surgeons rather than a want of supplies.[1] According to the late anesthetist Maurice Alban, the U.S. purchased one million ounces of chloroform and one million ounces of diethyl ether.[2] Breaking those down to the averages for each anesthetic agent if given pure, it's a minimum of 887,000 doses available throughout the conflict. This is due in large part to the very small doses required for general anesthesia. The authors of The Medical and Surgical History found that the average dose of chloroform was only 11 drachms, about three quarters of a shotglass. When supplies began to run lower after Antietam, Clara Barton was able to stave off disaster by delivering only ten pounds of chloroform to the army, which was apparently more than enough. The visceral scenes of Glory and Dances with Wolves are moving but ultimately fictional, because they portray situations in which well supplied U.S. forces are implied or explicitly said to have run out of chloroform.
What about the Confederacy?
Shortages were endemic in the Confederate Medical Department, to be sure, but anesthesia always seemed to be squeak by. Hunter Holmes McGuire claimed to have seen 28,000 operations under general anesthesia,[3] and J.J. Chisolm claimed an additional 10,000. Ferdinand Eugene Daniel summed up the broad situation nicely:
It has often been said that the Confederacy ran out of chloroform after Antietam or Gettysburg, but I haven't yet found any evidence for that. There are scattered reliable cases of capital amputations taking place throughout the conflict without anesthesia (about ten that I've tracked down), though not all are clearly from a lack of supply. When Edmund DeWitt Patterson of the 20th Georgia was operated on by his own cousin, he recalled "I wanted him to give me chloroform so that I would not suffer any more, but Frank said that it wasn't best and that it would soon be over and would not be very painful, so I must 'grin and bear it.'"[5] This could be a case of a lack of supply, excused by his surgeon/relative for some reason, or it could be that Dr. Patterson was an adherent of archaic and largely rejected medical opposition to anesthesia. Maybe there's some as yet unimagined motivation behind his decision, if it was a decision at all. We can't really say.
While I haven't found anything for lack of Confederate chloroform at Gettysburg or Antietam, I did find a serious supply crisis earlier in the conflict: The Seven Days Battles.
Rachel Frazier, a witness to the aftermath of White Oak Swamp, remembered that "the Confederates had our mess tent for their amputating tent, and having no chloroform, it was exceedingly painful to me to hear their poor soldiers' screams when their limbs were taken off by that indefatigable surgeon, Dr. [Daniel Burr] Conrad."[6] This lack of supply lasted for weeks after the battles. Private James Winchell of the 1st U.S. Sharpshooters was taken prisoner with a serious wound at Gaines Mill, and would undergo amputation weeks later. "About noon July 1st, Surgeon White came to me and said: 'Young man, are you going to have your arm taken off, or are you going to lie here and let the maggots eat you up.['] I asked if he had any chloroform or quinine or whisky, to which he replied 'no, and I have no time to dilly-dally with you.[']"[7] Another prisoner, only shortly after being taken prisoner, was denied treatment by a Confederate surgeon, but witnessed his fellow prisoners "put under the influence of chloroform, but a number of them regained consciousness during the operation, and swore worse than the British army did in Flanders, as they writhed in their agony."[8] While there was some chloroform available for those patients, it clearly wasn't enough.
The lack was serious enough that high ranking officers would undergo serious operations without anesthesia. The most telling case is that of Lt. Col. William Brandon of the 21st Mississippi. Brandon was himself a doctor in civilian life, and his insight is key to understanding what was going on.
While there were occasional shortages throughout the rest of the conflict, they were few and far between. Perhaps at Vicksburg (though that may have been confined only to the chloroform given to prisoners), probably on a small scale following Second Manassas.
Why didn’t the Confederacy’s patients suffer the lack of chloroform at much larger battles like Gettysburg?
Before the Seven Days, the Confederate Medical Department constructed a laboratory for local production of medical supplies. After the Seven Days, a dozen more were built in a flurry of construction stretching across the length of the Confederate States from Virginia to Texas. It is unclear to me if they were constructed explicitly because of the debacle of Seven Days or if they were already planned. Regardless, with very few exceptions, general anesthesia would be widely available to the Confederate wounded for the rest of the conflict. That fear of a lack of supply remained, but strong and largely successful efforts were made to ensure their patients would be provided for.
In the words of one rebel surgeon: "Chloroform always agrees with children; it always agrees with women in labor, and it always agreed with the Confederate soldier. What connects these different classes together? A woman is not afraid of an anesthetic, nor is a child, and a Confederate soldier was afraid the chloroform would give out before it got to be his turn to be operated on."[10]
Notes:
[1] Medical and Surgical History of the War of the Rebellion, Volume II, Part III, Washington Printing Office: 1883, page 887-898.
[2] Alban, Maurice, "The Use of Anesthetics During the Civil War," in Pharmacy in History, Vol. 42, No. 3/4, 2000, pages 99-114; Medical and Surgical, Vol II, Part III, 887-898.
[3] McGuire, Hunter M.D., L.L.D., “Annual Address of the President,” Transactions of the Southern Surgical and Gynecological Association, Volume II, Published by the Association, 1887, page 7, via HathiTrust Digital Library.
[4] Daniel, Ferdinand Eugene, Recollections of a Rebel Surgeon And Other Sketches: Or, in the Doctor's Sappy Days, Chicago: Clinic Publishing Co., 1901, via Google Books.
[5] Patterson, Edmund DeWitt, Yankee Rebel: The Civil War Journal of Edmund DeWitt Patterson, Kingsport, Tenn.: University of North Carolina, 1966.
[6] Frazier, Rachel, Reminiscences of Travel from 1855 to 1867, San Francisco, 1869, via Google Books.
[7] James Winchell, "Wounded and a Prisoner," appendix to Capt. C.A. Stevens, Berdan's United States sharpshooters in the Army of the Potomac, 1861-1865, St. Paul, Minnesota: Price-McGill Company, 1892, via Internet Archive.
[8] Roy, Andrew, Recollections of a Prisoner of War, Columbus, OH: J.L. Trauger Printing Co., 1905, page 30, via Google Books, accessed June 25, 2021.
[9] Brandon, William L., military reminiscences of Brandon, J.F.H. Claiborne Papers, 1797-1884, The Southern Historical Collection, University of North Carolina.
[10] Gordon C.P., M.D., "General Anesthesia by Chloroform or Ether, Which? Local Anesthesia by Cocaine or Eucaine, Which? General or Local Anesthesia in Enucleation or Extirpation of the Eye, Which?" in The Railway Surgeon, Vol. V., No. 11, October 18, 1898, page 246, via Google Books.
Throughout that research and over the year since then, I've been collecting whatever anecdotes or reports I could find regarding a lack of anesthesia.
Bellard, Alfred, “Drawing of a Civil War Leg Amputation from the Diary of Alfred Bellard, 1860s,” Civil War In Minnesota Lives
As has been stated many times (on this forum and elsewhere) it was incredibly rare that any surgeon would dare attempt a major operation without general anesthesia on hand. And for the United States forces, they never had to. The Medical and Surgical History of the War of the Rebellion showed that roughly 99.68% of surgeries conducted by United States surgeons were done with some form of general anesthesia (chloroform, ether, or a combination of the two), and attributes the minute number of cases where it was done without to misguided objection by the surgeons rather than a want of supplies.[1] According to the late anesthetist Maurice Alban, the U.S. purchased one million ounces of chloroform and one million ounces of diethyl ether.[2] Breaking those down to the averages for each anesthetic agent if given pure, it's a minimum of 887,000 doses available throughout the conflict. This is due in large part to the very small doses required for general anesthesia. The authors of The Medical and Surgical History found that the average dose of chloroform was only 11 drachms, about three quarters of a shotglass. When supplies began to run lower after Antietam, Clara Barton was able to stave off disaster by delivering only ten pounds of chloroform to the army, which was apparently more than enough. The visceral scenes of Glory and Dances with Wolves are moving but ultimately fictional, because they portray situations in which well supplied U.S. forces are implied or explicitly said to have run out of chloroform.
What about the Confederacy?
Shortages were endemic in the Confederate Medical Department, to be sure, but anesthesia always seemed to be squeak by. Hunter Holmes McGuire claimed to have seen 28,000 operations under general anesthesia,[3] and J.J. Chisolm claimed an additional 10,000. Ferdinand Eugene Daniel summed up the broad situation nicely:
"We were short on chloroform and had to use it as economically as possible-we had none to waste. We had to use such as we could get and could not be choice as to quality....Some that we used I know was adulterated. I remember a lot that smelled like turpentine. Well, sirs, I want to tell you now that I administered chloroform and had it administered for me many scores of times, for all manner of operations and on all sizes and ages and conditions of men...I do think it remarkable when I recall the perfect abandon, the almost reckless manner in which it was given to every patient put on the table, almost without examination of the lungs or heart and without injury. I can only attribute it in part to the fact that it was given freely, boldly pushed to surgical anesthesia, and no attempt was made to cut till the patient was limber."[4]
It has often been said that the Confederacy ran out of chloroform after Antietam or Gettysburg, but I haven't yet found any evidence for that. There are scattered reliable cases of capital amputations taking place throughout the conflict without anesthesia (about ten that I've tracked down), though not all are clearly from a lack of supply. When Edmund DeWitt Patterson of the 20th Georgia was operated on by his own cousin, he recalled "I wanted him to give me chloroform so that I would not suffer any more, but Frank said that it wasn't best and that it would soon be over and would not be very painful, so I must 'grin and bear it.'"[5] This could be a case of a lack of supply, excused by his surgeon/relative for some reason, or it could be that Dr. Patterson was an adherent of archaic and largely rejected medical opposition to anesthesia. Maybe there's some as yet unimagined motivation behind his decision, if it was a decision at all. We can't really say.
While I haven't found anything for lack of Confederate chloroform at Gettysburg or Antietam, I did find a serious supply crisis earlier in the conflict: The Seven Days Battles.
Rachel Frazier, a witness to the aftermath of White Oak Swamp, remembered that "the Confederates had our mess tent for their amputating tent, and having no chloroform, it was exceedingly painful to me to hear their poor soldiers' screams when their limbs were taken off by that indefatigable surgeon, Dr. [Daniel Burr] Conrad."[6] This lack of supply lasted for weeks after the battles. Private James Winchell of the 1st U.S. Sharpshooters was taken prisoner with a serious wound at Gaines Mill, and would undergo amputation weeks later. "About noon July 1st, Surgeon White came to me and said: 'Young man, are you going to have your arm taken off, or are you going to lie here and let the maggots eat you up.['] I asked if he had any chloroform or quinine or whisky, to which he replied 'no, and I have no time to dilly-dally with you.[']"[7] Another prisoner, only shortly after being taken prisoner, was denied treatment by a Confederate surgeon, but witnessed his fellow prisoners "put under the influence of chloroform, but a number of them regained consciousness during the operation, and swore worse than the British army did in Flanders, as they writhed in their agony."[8] While there was some chloroform available for those patients, it clearly wasn't enough.
The lack was serious enough that high ranking officers would undergo serious operations without anesthesia. The most telling case is that of Lt. Col. William Brandon of the 21st Mississippi. Brandon was himself a doctor in civilian life, and his insight is key to understanding what was going on.
Brandon was surprised at the lack of chloroform, and his surgeon was clearly nervous about proceeding without it. Especially interesting is the note about how it "was performed in an inconceivable short time." Prior to the widespread adoption of general anesthesia, speed was necessary in surgical operations, but that was a generation past. This was not how battlefield medicine was supposed to be practiced."[The surgeon] said there was no doubt of the propriety of an immediate amputation. I asked if he had chloroform, he said yes and proceeded. When I felt the tourniquet tighten on my leg, I called to him, I was not under the influence of chloroform. He said he had no more, & asked should he proceed? I replied 'off with it!' I supposed I could stand it. The operation was performed in an inconceivable short time, but the pain was horrible, particularly the tying up the arteries."[9]
While there were occasional shortages throughout the rest of the conflict, they were few and far between. Perhaps at Vicksburg (though that may have been confined only to the chloroform given to prisoners), probably on a small scale following Second Manassas.
Why didn’t the Confederacy’s patients suffer the lack of chloroform at much larger battles like Gettysburg?
Before the Seven Days, the Confederate Medical Department constructed a laboratory for local production of medical supplies. After the Seven Days, a dozen more were built in a flurry of construction stretching across the length of the Confederate States from Virginia to Texas. It is unclear to me if they were constructed explicitly because of the debacle of Seven Days or if they were already planned. Regardless, with very few exceptions, general anesthesia would be widely available to the Confederate wounded for the rest of the conflict. That fear of a lack of supply remained, but strong and largely successful efforts were made to ensure their patients would be provided for.
In the words of one rebel surgeon: "Chloroform always agrees with children; it always agrees with women in labor, and it always agreed with the Confederate soldier. What connects these different classes together? A woman is not afraid of an anesthetic, nor is a child, and a Confederate soldier was afraid the chloroform would give out before it got to be his turn to be operated on."[10]
Notes:
[1] Medical and Surgical History of the War of the Rebellion, Volume II, Part III, Washington Printing Office: 1883, page 887-898.
[2] Alban, Maurice, "The Use of Anesthetics During the Civil War," in Pharmacy in History, Vol. 42, No. 3/4, 2000, pages 99-114; Medical and Surgical, Vol II, Part III, 887-898.
[3] McGuire, Hunter M.D., L.L.D., “Annual Address of the President,” Transactions of the Southern Surgical and Gynecological Association, Volume II, Published by the Association, 1887, page 7, via HathiTrust Digital Library.
[4] Daniel, Ferdinand Eugene, Recollections of a Rebel Surgeon And Other Sketches: Or, in the Doctor's Sappy Days, Chicago: Clinic Publishing Co., 1901, via Google Books.
[5] Patterson, Edmund DeWitt, Yankee Rebel: The Civil War Journal of Edmund DeWitt Patterson, Kingsport, Tenn.: University of North Carolina, 1966.
[6] Frazier, Rachel, Reminiscences of Travel from 1855 to 1867, San Francisco, 1869, via Google Books.
[7] James Winchell, "Wounded and a Prisoner," appendix to Capt. C.A. Stevens, Berdan's United States sharpshooters in the Army of the Potomac, 1861-1865, St. Paul, Minnesota: Price-McGill Company, 1892, via Internet Archive.
[8] Roy, Andrew, Recollections of a Prisoner of War, Columbus, OH: J.L. Trauger Printing Co., 1905, page 30, via Google Books, accessed June 25, 2021.
[9] Brandon, William L., military reminiscences of Brandon, J.F.H. Claiborne Papers, 1797-1884, The Southern Historical Collection, University of North Carolina.
[10] Gordon C.P., M.D., "General Anesthesia by Chloroform or Ether, Which? Local Anesthesia by Cocaine or Eucaine, Which? General or Local Anesthesia in Enucleation or Extirpation of the Eye, Which?" in The Railway Surgeon, Vol. V., No. 11, October 18, 1898, page 246, via Google Books.
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