Articles  |   July 2014
The Civil War (1861-1865) and the Familiarization of American Medicine With Anesthesia and Anesthetics
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Articles   |   July 2014
The Civil War (1861-1865) and the Familiarization of American Medicine With Anesthesia and Anesthetics
ASA Monitor 07 2014, Vol.78, 28-30.
ASA Monitor 07 2014, Vol.78, 28-30.
The Civil War occurred during a lull in the progress of medicine in the U.S. Thus, it was not until 1867 that Joseph Lister published his paper on “The Antiseptic Principle of Surgery.” Later still, Louis Pasteur in 1880 and Robert Koch in 1882 demonstrated their revelations leading to the germ theory of disease. In this Civil War interim of four years, probably more than 700,000 deaths among the Union and Confederate military occurred. Infectious diseases (including enteric disorders) outnumbered battle wounds by a 2:1 ratio. Of course, battlefield wounds were also a terrible problem.
Although the clinical use of ether (ETH) was employed in 1842 (Crawford Long) and 1846 (William Morton), and chloroform (CHL) in 1847 (James Simpson), the use of these two agents was not generally popular in the medical cultures in the U.S. prior to the beginning of the Civil War. Rapid surgeons, the use of alcoholic drinks, the employment of physical restraints, opioid-bearing compounds and varied types of bite blocks were the conditions under which surgery was performed. It was also felt that the stimulating power of “cold steel” would have a salutary effect and not cause depression found with anesthetics. An important psychosocial factor present in the 19th century was that the female and child were more susceptible to the effects of anesthetics, while the male was more resistant to the side effects and complications. It was thought to be “unmanly” for a male to undergo an anesthetic and even complain or cry out as the knife begins to cut its way through tissue. In terms of the choice of anesthetic agents in military history, sulfuric ether was used by both the American and Mexican forces in the Mexican-American War (1846-1848). In the Crimean War (1853-1856), CHL was the agent of choice used by the British and French forces, with the French reporting the use of CHL in more than 25,000 cases without a single death, while the British noted 20,000 surgical procedures under CHL with but one fatality. On the other hand, the Russian opponents favored the application of ETH. Even though more than 30 different inhalers and vaporizers were developed since Morton’s use of ETH in 1846, during the Civil War, both ETH and CHL were delivered with the agent dripped over a cloth in the shape of a cone held lightly over the nasal-oral cavity. Since the overwhelming number of interventions were amputations, a very light plane of anesthesia was required.
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