'The smart of the knife'--early anaesthesia in the services

Some observations on early military anaesthesia

Although anaesthesia was discovered in 1846, pain relief had been used for many years previously. Opium, mandragora, and Indian hemp amongst others have been used since the earliest times as alluded to by many of the classical writers. The use of refrigeration anaesthesia is known to have been recommended a millennium ago although it never had much usage. Very soon after the introduction of ether anaesthesia, it was recommended for military use and the first use by the American forces was in Buena Vista early in 1847 and then again at Vera Cruz. Pirogoff taught and used ether anaesthesia on active service with the Russian forces in the Caucasus in the summer of 1847. Meanwhile Spencer Wells, who was serving with the Royal Navy in Malta, was the first British service medical officer recorded to have used anaesthesia. He went on to write up a series of 106 anaesthetics. The Danes were probably next to use anaesthesia in battle using chloroform in 1848. However, it was not until the Crimean War that anaesthesia began to play an important part in battle surgery with many anaesthetics being given with varying results. The War of the Rebellion was the next war in which anaesthesia was important and the first one in which proper statistics were kept allowing useful analysis. Anaesthesia had irrevocably found its place in battlefield surgery.

Amputations at the London Hospital 1852-1857

Between 1852 and 1857 at the London Hospital, 142 amputations were performed in 136 patients. The most common indication was an injury sustained at work. Overall mortality was 46% and the death rate was especially high for lower-limb amputations. Most deaths were due to postoperative sepsis. Those who received chloroform anaesthesia did worse than those who received ether.