Chloroform: Uses and Effects, Part 2

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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?

Here are a few primary sources selected for their descriptions of the use of chloroform. This is certainly not a comprehensive list of such examples, and admittedly these selected sources are eastern theater focused.

Charles Augustus Fuller from the 61^st New York Infantry Regiment was seriously wounded in the leg and shoulder on July 2, 1863, at Gettysburg. He knew that he would lose his leg and waited rather eagerly for the surgeons’ attention. Moved from field hospital to field hospital, he finally got the surgical aid he wanted and described his experience:

“Once there [at a field hospital] I was taken out of my stretcher…and taken at once to the operating table. A napkin was formed into a tunnel shape, a liberal supply of chloroform poured into it and the thing placed over my nose and mouth. I was told to take in long breaths. To me it seemed a long time before the effect came, probably it was a short time, but at last my head seemed to grow big and spin around. At this stage I remember a doctor had his fingers in the wound in the shoulder and said to the others “Here is a fine chance for a resection.” I did not know what that mean, but learned afterwards. When I came to myself, I looked down far enough to see a quantity of bandage wound about a stump of a leg eight inches long. My shoulder was bound up, but otherwise not operated on…. I was taken off the table and put back on my stretcher, which was set down in a wall tent, this tent was as full as it well could be of amputated cases…. During the night a doctor came, and gave every man a dose of morphine, which produced a happy state of mind and body. As I was taken from the table one of my doctors said, “Fuller, you may drink all of the whiskey you can get, and want.”[i]

As noted in Part 1, the Confederate practice of administering chloroform often included giving alcohol as a stimulant prior to anesthetic and surgery, but the Union doctors preferred to delay the strong drink until after the operation. Fuller is told to have some whiskey after the surgery. His point of memory loss in the chloroform experience is also noteworthy. He knew the doctor was examining the wound in the last minute before losing consciousness, but did not write about excessive pain in that moment as he did in earlier parts of his journey to the field hospital, suggesting the chloroform was well in effect.

Another soldier wounded at Gettysburg—Lt. Col. Henry S Huidekoper from the 150^th Pennsylvania Infantry—had a similar experience of semi-consciousness, to the point that he asked for more chloroform. It’s not quite clear from his request if he asked for more because of pain or because he did not want to know what was happening next in his operation. Shot in the elbow during the fighting on July 1, 1863, he lost his arm later that night in one of the churches in town:

“I went to the (operating) table and got onto it with my head towards the west. I took some chloroform but not enough, for I distinctly remember having said, ‘Oh, don’t saw the bone until I have had more chloroform.’ What I net remember was my saying, ‘You took my arm off, did you, Doctor?’ He was Dr. Quinan, Surgeon of my Regiment…. I then swung off the table feet first and was told to seek a place…to lie down.”^[ii]

Perhaps a more famous example of an officer under the influence of chloroform appears in Dr. Hunter McGuire’s writings. Confederate General Thomas J. “Stonewall” Jackson experienced relief from the severe pain of his wounds at Chancellorsville: “Chloroform was then administered, and as he began to feel its effects, and its relief to the pain he was suffering, he exclaimed, ‘What an infinite blessing,’ and continued to repeat the word ‘blessing,’ until he became insensible.”^[iii] However, apparently Jackson wasn’t as unconscious as a modern patient typically is under anesthetic because he later claimed that he heard the sweetest music and believed that was the cutting of bone during his amputation.

These three primary source examples give a patient’s experience with the successful administration of chloroform, but note that there are periods where they heard, felt, or knew what was going on. According to the medical manuals, the anesthetic was supposed to be administered slowly until the patient was unresponsive—however, unresponsive did not always mean the deeper unconsciousness that modern anesthesiologists are able to achieve and that state of unresponsiveness did not happen immediately. This understanding is helpful to remember when looking at primary sources describing hospital scenes.

Francis Adams Donaldson had walked himself to a field hospital after he had been hit in the arm during the Battle of Fair Oaks in the Peninsula Campaign. What he found at the temporary hospital reflects the scenes described by many soldiers and civilian on-lookers writing about Civil War medical care:

“I went back to the rear [of the house] and found four tables being used as operating tables, each of which was occupied, while the surgeons with sleeves rolled up were literally working up to their elbows in blood, so busy were they with knife and saw. One of the subjects then undergoing amputation seemed to be put partially under the influence of chloroform, he struggled so.”[iv]

Why are there so many accounts of patients shouting, screaming, and struggling in Civil War field hospitals if chloroform was regularly used? A few points to consider:

1. The anesthetic was only administered to that point of unresponsiveness, but the patient could still know what was happening.
2. If the patient was not resigned to their operation, they might be able to try to fight back under a weaker influence of chloroform. (Even in a “calm situation,” the Confederate surgical manual described a period of agitation as the chloroform took effect.)
3. Chloroform did not take effect immediately and did require patients to take deep inhales; if a patient was confused or uncooperative, he could have been given chloroform but not fully put under its influence, leading to a more conscious and extremely painful surgery.
4. Battlefield field hospitals were chaotic places, and the calm, lengthy instructions from the medical manuals were likely not the typical process, leading to a quicker administration of the chloroform which may or may not have been as effective to that “unresponsiveness” as the written manuals suggest.

There’s another point to consider: field hospitals ran out of chloroform. While many of the descriptions of struggling soldiers are likely linked to the previous four points, it is important to take the actual battle location, date, and—if possible—surgeon into consideration. Is the field hospital description linked to a battle where it’s known that medical supplies ran low? Is it early or later in the war, Union or Confederate? The Confederate supply shortages could contribute to a lack of chloroform. If the surgeon is identified, did he leave any writings that suggest he regularly used chloroform? Some doctors proudly noted its successful use in their major operations and may have even left notes saying they never did an amputation without it.

At the Confederate field hospital located at the John Cunningham Farm near Gettysburg, the civilians noted: “Father had no means of knowing how the battle was going until an order came to ‘use no more chloroform on Union soldiers’”[v] The observer seemed to believe that the order came through as retribution for the Yankees winning the battle. However, it is more likely that the Confederates were running low on chloroform and chose to prioritize their own wounded for the anesthetic rather than feelings of malice practiced on the operating table.

Over the years, I have talked about Civil War field hospitals and medical practices with many curious observers at living history events or more traditional presentations. The sigh of relief the listeners give when they hear that generally there were anesthetics regularly used for major operations during the Civil War is notable. I strongly suspect that is where a lot of listeners stop thinking about it and assume that chloroform or ether worked as effectively as our modern anesthetics. However, the truth suggested by primary sources is: chloroform did work…and sometimes it didn’t. So much depended on the patient, the skill of the doctors with the drug, and the actual situation at the field hospital to determine if the wounded soldier had a painless “unresponsive” surgery or not.

Chloroform was indeed a “blessing” for many wounded soldiers laid on the rough operating tables, but a deeper understanding of the theory of its administration and some examples of its use helps shed some light on the actual experience. No, hallucinations do not seem to be a regular effect of chloroform, but a soldier might have known more than he wanted to know about his operation as he lay unresponsive and relatively pain-free but still semi-conscious on a bloody altar of medicine.

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Sources:

[i] Charles Augustus Fuller. Personal Recollections of the War of 1861. (Sherburne: News Job Printing House, 1906. Reprinted by The Echo Library, 2010) 68.

[ii] Gregory A. Coco, A Vast Sea of Misery (Gettysburg: Thomas Publications, 1988) 16.

[iii] Hunter Holmes McGuire, Account of the Wounding and Death of Stonewall Jackson (Richmond Medical Journal, 1866).

[iv] Francis Adams Donaldson, edited by J. Gregory Acken, Inside the Army of the Potomac: The Civil War Experience of Captain Francis Adams Donaldson. (Mechanicsburg: Stackpole Books, 1998) 93.

[v] Gregory A. Coco, A Vast Sea of Misery (Gettysburg: Thomas Publications, 1988) 151-152.