Anesthesia was in its infancy when the American Civil War began in 1861. The sheer number of casualties gave surgeons on both sides the opportunity to gain experience with the first two anesthetic agents developed -- sulfuric ether and chloroform -- according to a paper by a University of Alabama at Birmingham anesthesiologist published in the October issue of the Scandinavian Journal of Pain.
"As we honor the sesquicentennial, or 150th anniversary, of the Civil War, it is still widely believed that the sole anesthetic agent used was the whiskey bottle," said Maurice S. Albin, M.D., professor in the UAB Department of Anesthesiology. "But sulfuric ether was first used in 1846, and chloroform a year later."
The Mexican-American War in the late 1840s and the Crimean War in the mid-1850s saw the first battlefield use of these agents on a small scale. In the Civil War, Albin estimates that anesthesia was used at least 125,000 times by surgeons for both the North and South who, before the war, had limited or no experience with anesthetic agents. That number pales in comparison to the estimated 476,000 men wounded on both sides during the conflict and 620,000 killed, many of whom no doubt underwent a surgical procedure.
Albin's paper reports on two wounded warriors, one a captured Union private and the other a celebrated Confederate general.
"These two case stories illustrate the profound improvement in surgical pain management made possible with anesthesia only 150 years ago," said Albin. "Most surgeons and patients today have no idea what these important improvements meant to modern medicine."
Albin, himself a World War II combat medic, tracked the story of Union Private James Winchell, a member of Berdan's First United States Sharpshooters. Winchell was one of 3,107 Union soldiers wounded at the Battle of Gaines Mill in 1862, and one of 2,836 captured. A musket ball struck his left arm between the shoulder and elbow. His group of some 500 wounded prisoners was treated by a single surgeon, so Winchell had to wait.
Five days passed before Winchell's shattered arm was removed, days he spent in great pain, lying under a tree shooing flies from his arm. Albin traced Winchell's story from a book on Berdan's Sharpshooters written by Captain C.A. Stevens, a veteran of the regiment who interviewed Winchell at a reunion in 1890. Stevens quoted Winchell's recollection of when the surgeon finally came for him. He was one of the many who did not receive anesthesia.
"I asked if he had any chloroform or quinine or whiskey," Winchell said to Stevens. "He said 'no, and I have no time to dilly-dally with you.'"
Winchell was seated in a chair, and men held his shoulders as the surgeon began to cut. After removing the bone, the surgeon suggested they pause an hour to let Winchell recover.
"I refused and told them I wanted one job of it, as I was just as ready to kick the bucket then as in one hour," Winchell told Stevens.
At this point, the surgeon and his men said of Winchell, "He's pretty spunky. Let's make a good job of it."
Amazingly, Winchell survived, was exchanged and returned home. Some 30 years later, he was still alive to tell his tale. The second individual in Albin's narrative was not as fortunate.
Lt. General Thomas "Stonewall" Jackson suffered a wound eerily similar to Winchell's. Jackson was shot in the left arm by nervous sentries from his own army following an evening reconnaissance during the Battle of Chancellorsville. He was taken to a field hospital and attended to by Hunter Holmes McGuire, a pre-eminent surgeon in the Confederate Army who determined that amputation of the arm was necessary. Chloroform was the anesthetic used, dropped on a cloth in the shape of a cone.
Jackson is recorded as saying "what an infinite blessing" as the chloroform took effect. A team of surgeons led by McGuire performed the operation to remove his arm. It took about 50 minutes, and he was under anesthesia for just over an hour, awaking shortly after. At first Jackson seemed to make a rapid recovery, but he developed pneumonia -- most likely from the arduous journey from battlefield to field hospital -- and died a week later.
Albin says the science of anesthesiology has come far since those days when a general got a few drops of chloroform and a private was lauded for his spunk.
"We now routinely do complicated, lengthy operations, using a variety of anesthetic agents that are best suited for each individual patient," said Albin. "Groundbreaking work done here at UAB and at other institutions has made remarkable progress in minimizing post-operative pain as well."
Battlefield medicine has also made great strides in recent years. Far-forward medical teams can provide emergency and surgical care to a wounded soldier within minutes, then transport him or her to a fully equipped theater hospital nearby. UAB is home to one of the most advanced military medical teams, the U.S. Air Force SOST-SOCCET special operations team.
- Maurice S. Albin. In praise of anesthesia: Two case studies of pain and suffering during major surgical procedures with and without anesthesia in the United States Civil War-1861–65. Scandinavian Journal of Pain, 2013; 4 (4): 243 DOI: 10.1016/j.sjpain.2013.07.028