Ami's SOA Timeline: Use of Ether and Chloroform Anesthesia

lelliott19

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Started by: @lelliott19

Laura's research was extensive and it’s a fascinating topic.
Let’s face it - most everyone on the site during their lifetime will have some type of anesthesia administered.
It’s interesting to see the “hits and misses” that went before us.​


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Use of anesthesia seems to be a common source of confusion related to Civil War and pre-Civil War medicine. A detailed timeline demonstrating the progression might be useful in helping readers better understand the evolution of anesthesia. There was great debate among physicians regarding the advisability of using ether and chloroform. Deaths resulting from the anesthetics were widely publicized and contributed to physicians' reluctance to adopt their widespread use. It's important to note that, by 1861, most physicians in the United States had finally come on board, and, during the Civil War, almost all operations and amputations were performed under the influence of general anesthesia.

Timeline: Use of Ether & Chloroform for Anesthesia

1842 - Georgia physician Crawford W. Long becomes the first physician to use ether as a general anesthetic during surgery.​
1846 - Boston dentist William T.G. Morton publicly demonstrates the use of ether as an effective surgical anesthetic.​
1847 - Scottish physician Sir James Young Simpson becomes the first to use chloroform as an anesthetic.​
1847 – Dentists at the Baltimore College of Dental Surgery perform chloroform experiments.​
1847-1848 - Military surgeons begin occasional use of inhalation anesthetics on the battlefield during the Mexican War.​
1848 – First fatality reported from use of chloroform (15 yo girl.) Fatalities widely publicized; physicians debate benefit v. risk of both anesthetics.​
1848 – Experiments conducted in Liverpool, England; chloroform is available for purchase by physicians in Boston, MA; use of chloroform is demonstrated for the first time at the University of Virginia Medical College.​
1849 – Ether is officially issued by the US Military for the first time; chloroform becomes available for purchase by physicians in Richmond, VA. Pennsylvania physician Washington L. Atlee utilizes a mixture of ether and chloroform to remove a large ovarian tumor at the new Pennsylvania College of Medicine.​
1853 – Queen Victoria undergoes anesthesia during the birth of her 8th child.​
1854-1856 - Chloroform is used almost exclusively by the British during the Crimean War; chloroform emerges as the anesthetic of choice there because it is thought to be faster-acting and lower risk. Debate continues among physicians regarding the "Dangers of Using Ether and Chloroform."​
1857- As if there wasn't already enough confusion, Dr. Snow introduces "Amylene" - a new anesthetic that he claims is safer and more effective than ether or chloroform - at the Medical Society of London.
1859 - The Imperial Society of Medicine, of Lyons declares that ether is the anesthetic of choice.​
1860 - Use of chloroform still considered "dangerous." Some physicians still reluctant to utilize ether or chloroform.​
Sources:
Images - wikimedia commons for free reuse.
Ether & Chloroform https://www.history.com/topics/inventions/ether-and-chloroform
Newspaper articles provided below:
Alexandria Gazette. (Alexandria, D.C.), December 25, 1847, page 2.
The Daily Union.(Washington, DC), January 12, 1848, page 1.
Richmond Enquirer. (Richmond, VA), January 28, 1848, page 2.
Baltimore Commercial Journal. (Baltimore, MD), February 05, 1848, page 5.
Richmond Enquirer. (Richmond, VA), February 06, 1849, page 3.
Jeffersonian Republican.(Stroudsburg, Pa.), April 12, 1849, page 3.
Daily American Organ.(Washington, D.C.), December 11, 1854, page 2.
Reprinted from the New York Evening Post in The Lancaster Ledger. (Lancaster, S.C.),January 17, 1855, page 1.
The Western Democrat. (Charlotte, NC), August 02, 1859, page 1.
New-York Daily Tribune., August 24, 1857, page 6.
Yorkville enquirer.(Yorkville, SC), February 02, 1860, page 2.
Watertown Republican.(Watertown, Wisconsin), December 07, 1860, page 2.

Dentists Harris and Bond of the Baltimore College of Dental Surgery experiment with the use of chloroform 1847.
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Use of chloroform as an anesthetic is first demonstrated at the University of Virginia Medical School in 1848.
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Experiments with chloroform continue in Liverpool England in February 1848.
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Baltimore Commercial Journal. (Baltimore, MD), February 05, 1848, page 5.

Chloroform becomes available to physicians in Boston, MA in January 1848.
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Chloroform becomes available to physicians in Richmond, VA in 1849.
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Richmond Enquirer. (Richmond, VA), February 06, 1849, page 3.

Prof. Washington L Atlee uses a mixture of ether and chloroform to destroy the sensation of pain but not consciousness as he removes an 8 pound ovarian tumor in Pennsylvania 1849.
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Jeffersonian Republican.(Stroudsburg, Pa.), April 12, 1849, page 3.

Debate continues over the safety of using ether and chloroform as anesthetics in 1854.
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Daily American Organ.(Washington, D.C.), December 11, 1854, page 2.

Debate continues on the dangers of using ether and chloroform 1855.
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Reprinted from the New York Evening Post in The Lancaster Ledger. (Lancaster, S.C.),January 17, 1855, page 1.

As if there wasn't already enough confusion, Dr. Snow introduces "Amylene" - a new anesthetic that he claims is safer and more effective.
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New-York Daily Tribune., August 24, 1857, page 6.

The Imperial Society of Medicine, of Lyons declares that ether is anesthesia of choice 1859.
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The Western Democrat. (Charlotte, NC), August 02, 1859, page 1.


Chloroform still considered "dangerous" Some physicians still reluctant to use anesthetics.
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Yorkville enquirer.(Yorkville, SC), February 02, 1860, page 2.

More on the dangers of chloroform - 1860.
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Watertown Republican.(Watertown, Wisconsin), December 07, 1860, page 2.
 
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Great timeline! I didn't know that anesthesia had already been in use for about 20 years before the war. That should clear doubts that amputations during the Civil War were done without anesthesia.

Prof. Washington L Atlee uses a mixture of ether and chloroform to destroy the sensation of pain but not consciousness as he removes an 8 pound ovarian tumor in Pennsylvania 1849.
This is fascinating! I don't know if I would want to be conscious for such a surgery. You wouldn't happen to know what became of the patient?
 
Chloroform use is generally what I think when referencing Civil War anesthesia. Was ether also used during the war?
Yes Alan. Ether is flammable and forms explosive mixtures as it vaporizes in presence of air. If the container was ruptured in transit, that would be bad. US Medical kits like the 1862 Medical Knapsack contained 12 oz of chloroform and no ether. Old habits are hard to break and some surgeons just preferred using ether. I guess they just used whatever was available. Some surgeons also used a combination of ether and chloroform.

I always thought it was just Confederate surgeons who used ether, but there are tons of examples of Union surgeons using it in the field and in actual General hospitals - even the renowned Union surgeon Dr. Reed Bontecou used it on occasion. (He's the guy that took all those graphic images of wounded soldiers you see.)

Here's an example from June 1864 at Stanton US Hospital, Washington, DC. You'd think that chloroform was available there, but Dr. Lidell chose ether.
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The Medical and Surgical History of the War of the Rebellion, (1861-65). Volume 2. Part 1. Washington, Govt. Print. Off., 1870-88. page 559.
 
Laura, great work!!
To get an idea what the development and use of anesthesia meant for the patient, I cannot recommend the book "The century of the surgeon" by J. Thorwald highly enough!! It is written as a narrative, and it took my breath away to read what people back then had to go through before! The book is currently out of print, but there are used copies a available and it is on archive.org albeit only as a "to borrow" copy.
I bet Thorwald would have loved to use your work as source!
 
Thanks @lelliott19 for awesome information of the use of anesthesia. The use anesthesia during the civil war was a great challenge. There were so many wounded men that were what the doctors thought that needed to have limbs or legs amputated because of blood lost, broken bones, etc. to hopefully save their lives. After so many amputations. The use of anesthesia ran out!
 
I find it amazing how different people will take different points from threads that are posted here. Imagine 1853 after having 7 children, Queen Victoria had anesthesia during the birth of her 8th. A 29 year old woman has an 8 pound ovarian tumor removed - and lives to tell about it - 1849. At what point did chloroform as an anesthetic become obsolete? It’s an interesting time line - thank you for posting it.
 
I've always had a terrible time reading about operations before anesthetic. Didn't operations include strong men who held patients down? Can you imagine? If you were lucky you passed out from sheer pain. You know the whole ' bite the bullet ' thing? That was anesthetic.

Great thread, thank you! And one more legacy from Queen Victoria. When she resorted to it, it became OK not to suffer through child birth. That's changing but it was nice while it lasted.
 
I had no idea anesthesia was in use before the Civil War.
I had no idea anesthesia in general was being used regularly that early.
It really wasn't in "regular" use that early - at least not by most ordinary doctors - in small towns and out in the country.

Only newly trained physicians in or after 1848 would have seen it demonstrated during their series of lectures. And then, only those who attended the larger medical schools in New York, Philadelphia, and Richmond. Smaller medical schools would have probably added it in 1849/50 or later - whenever they got a staff member who had been trained to do it.

Older doctors, and even young ones who had attended lectures prior to 1848/1850, would have zero knowledge or training in the use of ether or chloroform. So even though it was available for purchase, most doctors had no idea how to use it. :unsure:

Also, there was a ton of controversy about the dangers of ether when it was introduced. Then chloroform came along and suddenly there was even more controversy. There were widely publicized deaths from the use of both, so some doctors just waited to see how it would shake out. Was either of them safe to use? Which one worked better? I guess I can see why doctors who had no training would be reluctant to jump on the bandwagon. After all, doctors had been doing surgery without anesthesia for - well, forever - and they weren't the one being operated on. :cold:
 
You wouldn't happen to know what became of the patient?
No, the news article didn't list her name. That was quite an unusual case. And yes, I agree that I would not have wanted to be conscious either. I'm guessing that the doctor was reluctant to put her all the way under. There was just soooooo much controversy over the use of anesthesia at all.
Didn't operations include strong men who held patients down? Can you imagine? If you were lucky you passed out from sheer pain.
Indeed. Just think, before anesthesia, a couple or three big strong men would hold you down and the doctor would saw away. There was no such thing as elective surgery because no one would have elected it.:cold:
"The century of the surgeon" by J. Thorwald
Thanks! I'll have to check that out.
At what point did chloroform as an anesthetic become obsolete?
Good question DBF. Chloroform was used as the anesthetic of choice for roughly a hundred years - until the mid-1900's. It's no longer used because of its harmful and dangerous side effects.
 
You will like this story - in about 1915, my grandmother acted as the anesthetist as the local Dr took out my uncle's tonsils on the ironing board as my father looked on. She used chloroform!
 
This is one subject that provides a source of empathy for Civil War soldiers, as I am old enough to have experienced a couple of surgeries where Ether was used. I awoke after surgery by throwing up everything I had in my tummy. Still makes me queasy thinking about the odor!!!!
Great thread and thank you for sharing.
Regards
David
 
Thank you for the additional information. I have been doing some searching and found that Hannah Greener of Winlaton, near Newcastle in the United Kingdom, was the 15 year old that died on January 28, 1848, after receiving a chloroform anesthetic for the removal of a toenail. How sad is that?
https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1945064
 
Private Samuel R. Greene, Company A, 5th New Hampshire. Wounded in the leg on 2 July [1863] at Gettysburg by a minie ball which fractured the tibia and fibula. Amputation at middle third of leg performed at a field hospital by Surgeon C. S. Wood, 66th New York. Patient killed by chloroform, died at Seminary Hospital on 30 July. (The Medical and Surgical History of the War of the Rebellion, (1861-1865), prepared in accordance with acts of Congress, under the direction of Surgeon General Joseph K. Barnes, United States Army; Washington D.C.: Government Printing Office, 1883, part III, volume II, Surgical History, p. 895)

On 7 July [at Gettysburg], the Surgeon of the 2nd Corps hospital gave me a list of his supplies when the army commenced its pursuit of the rebels – a few stretchers, eight pounds of chloroform, one box of bandages, 16 rolls of plaster, and three pounds of lint, for 1,600 wounded. (Isaac W. Monfort, Indiana Military Agent)
 
Thanks for all the great replies and additional information! I found this great article by Dr. Shauna Devine, a historian of Civil War and American medicine. Although not exactly a timeline, in this article, Dr. Devine chronicles the introduction of general inhalation anesthesia. Here's a snippet:
Although the agent became part of the standard army supply table in 1849, and had been used in civilian practice, it was not until the American Civil War that the use of anesthetics became standard practice for the many American physicians. The Union records show that of more than 80,000 operations performed during the war, only 254 were done without some kind of anesthetic....
Read the entire article here: http://www.pbs.org/mercy-street/blo...-art-of-practice-and-the-science-of-medicine/
 
Another interesting statistic from the linked article in #18 - - -

As the request of Surgeon General Joseph Barnes, “noted physician” George Otis analyzed - - -

“Of 1710 cases analyzed, Otis found that chloroform was used in 1000 cases, ether in 500 and a mixture of the two in 210. In most cases, when a patient died after the administration of anesthetics, it was within 5-10 minutes. Surgeon McParlin, Medical Director of the Army of the Potomac, Surgeon Cooper, Medical Director of the Army of the Cumberland, Surgeon Moore, Medical Director of the Army of the Tennessee and Surgeon Ghiselin, Medical Director of the Middle Military Campaign for the summer campaign of 1864, together recorded 5284 cases in which chloroform was administered in primary operations of gun-shot wounds. Otis also determined that 5022 cases in general hospitals used anesthetics in primary operations. Overall he estimated that more than 80,000 wounded patients had been administered chloroform. Otis concluded “that we have had fatal accidents to deplore from the use of chloroform” but the number of deaths was quite low in relation to use. He could not in 1865 judge how many. But years later in the Medical and Surgical History it was estimated that there were only 37 deaths or rather 5.4 deaths for every thousand cases.”

Just out of curiosity, I searched for deaths (1999-2005).

“Each year in the United States, anesthesia/anesthetics are reported as the underlying cause in approximately 34 deaths and contributing factors in another 281 deaths, with excess mortality risk in the elderly and men.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/
 
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