Chloroform: Uses and Effects, Part 1

Did chloroform cause patients to hallucinate? The simple question stemmed from some late-night fiction writing of mine in which a character endures a somewhat prophetic nightmare while supposedly on an operating table under the influence of chloroform. While the fictional scene turned out pretty good in a terrifying way, it will have to get scrapped or put under the influence of a different painkiller in the story. From a quick glance over medical sources and wounded soldiers’ experiences, it seems that chloroform either worked or it didn’t (based on the skill with which it was administered), but confused dreams do not seem to be the regular experience of the patients.

Turning to primary and secondary sources on the topic of chloroform gives a greater appreciation for the pain-relief that was available to soldiers on the Civil War operating tables and a better understanding of what they saw or experienced in those hospital settings.

First, some statistics to clear up the myth that surgeons routinely operated on patients without painkillers. According to Union records, anesthetics were administered approximately 80,000 times and chloroform was used the majority of the time. Thirty-seven deaths were attributed to chloroform from that overall number.[i] Confederate Medical Director Hunter H. McGuire believed that chloroform had been given at least 28,000 times in the field hospitals of the Second Corps of the Army of Northern Virginia, and he claimed no deaths caused by the anesthetic.[ii]

Since the mid-1840’s doctors had been experimenting with anesthetics, starting with ether and then moving to the less flammable chloroform in 1851. However, the majority of doctors did not have training to administer the drug and some recorded mishaps from the Mexican-American War and Crimean War with the drug vapors caused some Civil War surgeons to be skeptical or downright hostile to the painkiller.[iii]

Why the opposition? An 1861 medical journal published in New York claimed:

1. A wounded soldier had enough “excitement” to get him through any operation.
2. Physical shock after gunshot injuries would be dangerously increased by the administration of an anesthetic.
3. Pain is necessary when a patient was in shock.
4. An anesthetic would slow the healing process and directly cause additional bleeding or infection.[iv]

On some occasions, wounded soldiers refused chloroform, but the majority seemed grateful for the pain relief during their operations. Even stoic “Stonewall” Jackson called chloroform a “blessing.”

In a unique medical situation, it is perhaps possible that more women had received chloroform than men prior to the American Civil War. Why? Childbirth. Much of the early experimentation and successes with the drug had been practiced on women in labor. If administered properly, it could dull the pain but still keep the woman able to physically assist with the delivery. When Queen Victoria of Great Britain used chloroform in 1853 for the delivery of her eighth child and later in 1857 at the birth of her last child; the queen’s acceptance of chloroform helped lead to its acceptance in “proper society.”[v]

The American Civil War gave medical men an opportunity to experiment and learn like most of them had never experienced before. One of the great triumphs of the medical field was a better understanding of quickly administering chloroform.

So, how was it administered in field hospital or more established medical ward during the 1860’s? Both sides wrote about it in their military medical manuals:

According to the Federal 1861 Manual of Military Surgery:

Anesthetics should be given only in the event of thorough reaction; so long as the vital powers are depressed and the mind is bewildered by shock, or loss of blood, their administration will hardly be safe, unless the greatest vigilance be employed, and this is not always possible on the field of battle, or even in the hospital. Moreover, itis astonishing what little suffering the patient generally experiences, when in this condition, even from a severe wound or operation. In the war in the Crimea, the British used chloroform almost universally in their operations; the French also exhibited it very extensively, and Baudens, one of their leading military surgical authorities, declares that they did not meet with one fatal accident from it, although it was given by them, during the Eastern campaign, thirty thousand times at least. The administration of chloroform is stated by Macleod to have contributed immensely to the success of primary amputations.[vi]

How was chloroform supposed to be administered? The Confederate Manual of Military Surgery, published in 1863, gave detailed advice for the process in a calm and controlled setting:

A bed for the patient should be prepared, preferably in the open air, if the weather will permit, or in a room which may be quickly and freely ventilated by currents of fresh air. The patient, placed upon it, should have the head supported but by a single pillow, as it is very important that he be put and kept in the horizontal posture… The clothes should be loosed from about the neck, chest and abdomen, in order that the respiratory movements may be unimpeded…. The best time is, possibly, soon after the patient has digested a light, but nutritious meal—as the stomach is then empty and the patient strong. All special instruments of inhalation have been discarded, and a towel or napkin, folded into a cone, by having its corners turned down, is now almost universally employed for the purpose. The chloroform…is poured into this cone, and is held over the patient’s mouth and nostrils. “When the inhalation is about to commence, the surgeon should address a few kind and encouraging remarks to the patient, telling him that all that is required of him is to be still, and breathe naturally, and that the uncomfortable feeling of suffocation, which is frequently experienced, will soon pass off; upon the assistants he should enjoin silence, and upon the administrator the strictest attention to the condition of the respiration, pulse and countenance. The administrator will now gradually bring the inhaler towards the patient’s face, until it is within half an inch, and should never carry it further for fear of…excluding entirely the air. A proper admixture of air is always required in the inhalation of chloroform. It has been recommended, in the case of the feeble and timid, always to precede the inhalation by the administration of brandy, or brandy and a few drops of laudanum, and if the operation is long continued, to allow the patient to sufficiently recover to have it repeated. It has become an almost universal practice with surgeons in our own service to use the brandy in all cases before resorting to the anesthetic. The practice is a safe one, and should not be omitted. The phenomena produced by the anesthetic have been divided into two stages: the first, one of excitement; the second, one of unconsciousness, insensibility and relaxation. The excitement is first shown upon the brain as the organ of intellection and sensation, then we have the mutterings, the wild eye, the cries, the exalted imagination, displaying themselves according to the peculiarities of the patient or the impressions made by circumstances. We have next the voluntary motions interested, as expressed by violent struggles, attempts to rise, and rigid contraction….The actions of the nervous centres are, in the same regular gradation abolished, and we have unconsciousness, insensibility and relaxation of the voluntary muscles. The patient cannot be aroused, call him ever so loud, nor move, inflict what we may; the eye-lids no longer contract when the conjunction is touched,—the reflex functions are suspended, and the organic nerve centres alone are active. The inhalation has been carried as far as is either necessary or safe. It is maintained by the occasional repetition of the inhalation….[vii]

The medical volumes are helpful for understanding the theories of how chloroform was supposed to be used, but what about the actual experience of soldiers put under its influence for an operation? And why are there so many primary source accounts of soldiers struggling on the operating tables if chloroform (and other anesthetics) were regularly used?

These questions will be explored tomorrow in Part 2…

Sources:

[i] George Worthington Adams, Doctors in Blue: The Medical History of the Union Army, (Baton Rogue: Louisiana State University Press, 1952),119-120.

[ii] H.H. Cunningham, Doctors in Gray: The Confederate Medical Service, (Baton Rogue: Louisiana State University Press, 1958), 227.

[iii] George Worthington Adams, Doctors in Blue: The Medical History of the Union Army, (Baton Rogue: Louisiana State University Press, 1952), 119.

[iv] Ibid., 120.

[v] “Anesthesia and Queen Victoria,” Accessed on August 31, 2021. https://www.ph.ucla.edu/epi/snow/victoria.html

[vi] S.D. Gross, A Manual of Military Surgery, 1861. Chapter VI Accessed on August 20, 2021. https://jdc.jefferson.edu/milsurgusa/

[vii]A Manual of Military Surgery, Confederate States of America, 1863, pages 72-73. Accessed on August 20, 2021. https://jdc.jefferson.edu/milsurgcsa/1/