The Dawn of Anesthesia in the Civil War

- Leila “Izzy” Jones

By the time the American Civil War began, two anesthetic agents had been developed and were already in routine use in American hospitals. The options were diethyl ether and chloroform, the first substances capable of producing general anesthesia suitable for surgery. Their widespread use in the painful operations of the Civil War firmly established anesthesia as the standard of care and provided physicians with opportunities to refine its administration. Surgeons discovered optimal delivery techniques, recognized its limitations, and alleviated the suffering of thousands of soldiers undergoing lifesaving procedures. This era laid the foundation for anesthesiology to emerge as a dedicated specialty and evolve into the robust field of medicine it is today.

Diethyl ether had been discovered in 1525 by Paracelsus, yet its clinical utility remained unrecognized for centuries (Hargrave, 2025). Not until October 16, 1846, did Dr. William T. G. Morton publicly demonstrate its effectiveness at Massachusetts General Hospital in what became known as the “Ether Dome.” His patient, Edward Gilbert Abbott, inhaled ether vapor until unconscious, at which point Dr. John Collins Warren excised a vascular tumor from his neck. Abbott remained immobile throughout the procedure and later reported no pain. Morton, effectively the first practicing anesthesiologist, famously declared to the assembled audience of physicians and students, “This is no humbug!” (MassGen). The demonstration marked a turning point in surgical practice and introduced the world to the possibilities of pain-free operations.

Chloroform, however, would soon surpass ether in popularity, especially during the Civil War. First synthesized independently by several scientists in 1831, chloroform’s anesthetic potential was not recognized until 1847 (History of Anesthesia). That year, Scottish obstetrician Dr. James Y. Simpson and two colleagues experimented with various inhaled substances in search of an alternative less irritating and less flammable than ether. After inhaling chloroform vapors from handkerchiefs in Simpson’s living room, the trio abruptly lost consciousness. Upon regaining their senses, they realized its extraordinary potential. Simpson quickly incorporated chloroform into his obstetrics practice, easing labor pain for countless women. By 1853 Queen Victoria even received chloroform during childbirth, solidifying its respectability (SOAP). Compared with ether, chloroform offered rapid onset, reduced airway irritation, and, crucially for military settings, far lower flammability. These qualities made it the preferred anesthetic of Civil War surgeons working in field hospitals vulnerable to fire and explosion hazards (Dalton, 2020).

Although both ether and chloroform had been adopted enthusiastically in the United States and abroad, the Civil War was the first large-scale conflict to apply them systematically, thereby transforming anesthesia into the standard of surgical care. The unprecedented volume of operations, particularly amputations, allowed surgeons to refine their dosing strategies and gain a better understanding of anesthetic physiology. Chloroform was most often administered using a cone-shaped sponge or a rigid cone lined with a chloroform-soaked sponge. When held over the patient’s nose and mouth, unconsciousness was typically achieved within about nine minutes (Reimer, 2017). With careful administration of additional chloroform in the same manner, unconsciousness could be maintained for fifteen to thirty minutes, long enough for the majority of battlefield procedures.

Amputation was by far the most common surgery requiring anesthesia, with over 60,000 performed during the war. Approximately 95% of all operations utilized ether or chloroform (Reimer, 2017). At this volume of use, complications inevitably arose. Some patients received excessive doses too rapidly and never regained consciousness. Chloroform depresses cardiac and respiratory function, and in rare cases this suppression became fatal. Contemporary estimates suggest a mortality rate of about 5.4 deaths per 1,000 anesthetic administrations, often in patients already gravely wounded or otherwise unstable (Devine, 2016). Civil War physicians learned from these rare complications and grew adept at anesthetic delivery. Their collective experience helped establish anesthesiology as a discrete medical discipline in the postwar years.

The timing of anesthesia’s discovery was extraordinarily fortunate. It spared thousands of soldiers the agony of surgery and allowed surgeons to operate with greater precision, producing improved outcomes. Chloroform was even administered during the amputation of General “Stonewall” Jackson’s arm. As he drifted into unconsciousness, he is reported to have remarked, “What an infinite blessing” (“Battle of Chancellorsville”). Though Jackson later died from his injuries, many others survived due to the skilled use of chloroform, which became known among troops as a “soldier’s best friend during a painful surgery.”

Despite chloroform’s ubiquity, the image of Civil War soldiers “biting the bullet” during amputations persists in popular memory. This enduring myth likely reflects earlier practices, when patients might bite on leather straps or wood to endure pain before anesthesia became widespread. However, no reliable records exist of Civil War soldiers using bullets in this way, and physicians most likely would not have permitted such a dangerous choking hazard. Discoveries of bitten bullet casings are better explained by the gnawing of pigs on abandoned battlefield debris (Reimer, 2017). Combined with the enormous number of amputations, these artifacts gave rise to a legend of stoic heroism that has since overshadowed the historical reality that chloroform, not grit, spared soldiers from agony.

Ultimately, anesthesia proved to be a transformative medical innovation that arrived just in time for the Civil War. It enabled surgeons to perform complex procedures with greater accuracy while drastically reducing patient suffering. Its extensive wartime use generated a wealth of clinical experience, demonstrating that anesthesia was both safe and effective when administered properly. The Civil War thus solidified anesthesia as an indispensable component of surgical practice and accelerated the growth of anesthesiology as a specialty, laying the groundwork for the discovery of many more sophisticated pharmacologic agents in the decades that followed.