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Ether and Chloroform Were the Anesthetics of the U.S. Civil War

Chloroform had a fatality rate of 1 in 3,000, but that didn't stop doctors for using it for roughly 100 years, starting in the mid 19th century.

The science of anesthesia wasn't always as advanced as it is today. In the mid-1800s when the American Civil War took place, the common anesthetics were chemicals called ether and chloroform. 

In 1846 the world was introduced to the general anesthetic ether that was inhaled for use. This was closely followed by the introduction of chloroform in 1847. You know, the highly dangerous chemical that can be used to make people pass out if inhaled.

The timing of these anesthetics was particularly interesting from a historical perspective because it meant that they would come into prominence as war anesthesia during the civil war. 

Anesthetic in the Civil War

Civil war doctors were fairly new to the idea of anesthetic in general, though some had heard of earlier uses. Doctors had heard of chloroform being used in operations, but most had no experience with the chemical. 

It really wasn't until American physicians experienced mass casualties in the civil war that using anesthetic in surgery became common practice. According to historians, the Union, or the north in the U.S. Civil War, has a record of over 80,000 operations done during the civil war with only 254 noted to be without anesthetic of any kind. 

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Largely before that time period, those numbers would've been reversed. 

So then, how would doctors administer the chloroform or ether to the patients to knock them out?

Doctors and field hospitals would soak a piece of cotton with the chemical and fasten it to the inside of a cone. This cone was then placed on the patient's nose and mouth. The patient would then inhale the chemical and fall into a deep sleep. This practice, for the most part, was done during the war without too many negative side effects, even with such a harsh early anesthetic. That said, there were issues with the chemicals.

Problems with the use of chloroform

The chemicals were fairly new in the min-1800s and so was the idea of being put out completely for a surgery. While today it sounds gruesome to be awake during something like an amputation, back then, patients and doctors alike were still unsure. 

By this time in the history of these anesthetics, there were reported and studied deaths from chloroform inhalation that were causing concern. When chloroform was first used in the 1840s, physicians around the world heavily investigated the first deaths, which occurred soon after its introduction.

At the time, people weren't really sure what was causing these deaths, as for the most part the chemical was doing its job as a general anesthetic. Modern medicine now recognizes that when chloroform is administered improperly in the wrong dosage, it can cause sudden cardiac arrest. 

It was this misunderstood cause of death that puzzled scientists and doctors during the civil war. 

Near the end of the war, the United States Surgeon General issued a message to all doctors at the time. He called for strict guidelines around anesthetic use and if a death were to occur, he required detailed reporting from doctors or hospitals. This was done in part to protect patients, but also to provide a standard of collecting data on the negative effects of chloroform, when things don't go according to plan. 

Overall, there weren't that many deaths during the war due to the improper delivery of chloroform. This is surprising given what we know now about the dangers of the chemical. In the end, the implementation of chloroform during the civil war saved thousands from the grueling pain of anesthetic-less surgery on the battlefield. It also laid the foundation for the modern world of anesthesiology. 

Chloroform in the years after

Chloroform along with ether continued their dominance as general anesthetics in the field of medicine until the early 20th century. Over the years there continued a battle between supporters of the chemical and opponents, mostly at odds over whether the complications that caused death after inhalation were caused by the chemical itself or an issue with a blocked airway. Between 1865 and 1920, chloroform was used in up to 95% of all fully-sedated surgeries.

It wasn't until 1911 that scientists first discovered that a direct link between chloroform and cardiac fibrillation.

Years after this final nail in the coffin for the prolific anesthetic, doctors started looking at the statistics surrounding the various anesthetics they had on hand. Ether, a far safer anesthetic but far less popular over the years, had fatal complications roughly ever 1:15,000 uses. Chloroform, on the other hand, had fatal complications roughly ever 1:3,000

By the early 1930s, nitrous oxide had been discovered which was far safer of an anesthetic and is still used today. Just be thankful that when you go in for a dental surgery, you don't have a doctor holding a chloroform rag over your mouth.

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