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William Thomas Green Morton as a Military Anesthetist during the Civil War
BULLETIN OF ESTHESIA
1ST RY
VOLUME 14, NUMBER 1
JANUARY, 1996
William Thomas Green Morton as a Military Anesthetist during the Civil War Maurice S. Albin, M.D., M.Sc.(Anes.) Professor of Anesthesiology and Neurosurgery University of Texas Health Science Center at San Antonio
With the sesquicentennial celebration of the use of sulfuric ether by Morton at the Massachusetts General Hospital (October 1 6, 1 846) shortly upon us, it becomes fitting to examine a little known aspect of this pioneer-the dedicated military Anesthetist. Most of this infor mation concerning Morton's venture into military anesthesia comes to us from a paper published in the JAMA in 1 904 and furnished by his son, William J. Morton, M.D., then residing in New York City.l Apparently, it was written after the battle of the Wilderness in May, 1 864, in which Morton relates his Civil War experiences. It appears that Morton's military anesthesia experiences started dur ing the B attle of Fredericksburg on December 1 3 , 1 862, which was a definitive Confederate victory and which ended on December 15, 1 862, when the Commander-in-Chief of the Union Army, Major General Ambrose Burnside, ordered the Union Army to retreat to the eastern bank of the Rappahanock River. The battle was extraordinarily costly to the Union since their casualties numbered about 12,600 against 5,300 for the Confederates. More than 6,000 Union casualties occurred dur ing the attack on Maryes Heights where the bodies were stacked so high that they had to be trod upon by the attacking Union soldiers 2•3 It appears that Morton was notified by the Surgeon-General of the Union Army that his services would be required prior to the Ba ttle of the Wilderness which commenced on May 4, 1 8 64, and continued through May 6, 1 8 64. This battle resulted in more than 1 7,600 Union casualties and 7,500 Confederate ones. 2•l Shortly thereafter, General Grant turned his Army of the Potomac southeast and tried to outflank the Army of Northern Virginia, commanded by General Robert E. Lee, beginning the battle of S potsylvania which lasted from May 8 through May 1 8 , 1 8 64. This battle caused more than 1 7,500 Union dead and wounded while the Confederates suffered 1 0,000 losses. The combined casualties of the l ast two cited b attles were 35, 100 for the Union and 1 7,500 for the Confederation. 2•l There is certainly no doubt that the talents and services of Morton were needed. In his article, Morton noted that many of the wounded from the B attle of the Wilderness were taken to Hospitals in Fredericksburg, many of which had been churches, and he notes that "one of the principal hospitals was the B aptist Church which was l iterally packed with wounded. The tanks intended for immersion were used as a bathing tub, and the operations were performed in the pastor's small study back of the pulpit." As can be imagined, the transport of the wounded over virtually nonexistent roads brought about u nimaginable suffering to these poor souls. Morton writes that "The ambulances could not have brought one tenth part of them, and the rest were brought in wagons, eleven or twelve miles over the remains of a planked road, worn by war-travel. In places the larger wagons had to be pried out of the deep holes with trimmed trees . . . On such a highway, and in such a manner did these poor fellows, who stretch their hands out of these ambulances and army wagons for tin-cupfuls of water, painfully travel-some with arms off at the shoulders, some with legs off below the knee, some with an arm and leg both off, hundreds shot through the leg or arm, or the breast, some with horrible wounds of the face-even to the loss of the j aw and the destruction of speech-all presenting in the aggregate every Continued on Page 23
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BULLETIN OF ANESTHESIA HISTORY
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for wn tor
e Ie al le as
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02 Therapy. . . Continued from Page 22 resolved to a d m i n i ster the very e l e m e n t he craved . . . I gener a ted oxygen from chlorate of po tassium and b l a ck oxide of man ganese i n large test tubes over a spirit l amp, and with rubber tub ing I c o n d u c t e d the gas to the b o ttom of a b u cket fil l e d with water which I had placed beside the patient's bed. Then, with a fan, the gas was wafted i nto the patient's face . . . The effects on the respira tion and his color were distinctly appreciated by the par ents and those around the bed side of the young man. I repeated the adm inistration a number of times during the day until i t was n o l o nger n e e d e d . The p a t i e n t
Dr. Morton.
recovered rapidly. R a t h e r to h i s own a s t o n i s h m e n t , George E. Holtzapple, barely out of medi cal school, had disc-o vered the first effec tive treatment for pneumoni a . Until Alexander Fleming's discovery of peni cillin in 1 928, oxygen therapy remained the only effective treatment. Among the thousands of l ives that were saved by Dr. Holtzapple's discovery was that of his own sister, Mrs. Mary S to ver. When she caught pneumonia, he put her into an oxygen tent. During World War I, portable oxygen tents at the front proved effective not only in treating pneumoni a, but also in sav ing victims of poison gas attacks. Today, oxygen therapy is still used to save vic tims of shock, including surgical shock. It is also used to treat heart disease, se-
23
vere migraine, and a variety of other ail ments. Dr. Holtzapple made no money from his discovery, but he received a note of congratulations from King George V of England, and an honorary doctorate from S usqu e h a n n a Univers ity. The d oc to r spent t h e rest of his life practicing medi cine in rural York County, Pennsylvania. He was remembered there as a church going family man who played a variety of musical instruments. Dr. Holtzapple was nearly eighty-four when he died in York, Pennsylvania, on February 22, 1 946. Standing at his bed side during the final days was Fred Gable, aged seventy-seve n . Fred lived to b e ninety-one. He died i n 1 960 a t the Lutheran Home for the Aged in Wash ington, D . C .
. . Continued from Page 1
possible variety of gunshot wound . . . " Morton also speaks of the wounded soldiers going to the rear area and says "it is the most sickening sight of the war, this tide of the wounded flowing back. One has a shattered arm, and the sling in which h e carried it is the same bloody rag the surgeon gave him the d ay of the battle; another has his head seamed and bandaged so you can scarcely see it, as he weaves like a drunken man as he drags along through the hot sun. . . " Morton describes h i s involvement a s an anesthetist a n d t h e organization of the triage system and the field hospital ser vice, put i n place by the Medical D irec tor of the Army of the Potomac, Major Jonathan Letterman. Morton states that "On S aturday morning, May 1 4, I was awakened by the booming of cannon and learned that the enemy were endeavor ing to regain their lost position . . . On the arrival of a train of ambulances at a field hospital the wounds were h astily examined, and those who could bear the j ou r n e y w e r e s e n t a t o n c e t o Fredericksburg. The nature of the opera tions to be performed on the others was then decided on and noted on a bit of paper pinned to the pillow or blanket un der each patient's head. When this had
been done I prepared the patients for the
knife,producing perfect anesthesia in an av erage time of 3 minutes [emphasis MSA],
and the operators followed, performing operations with dexterous skill, while the dressers in t h e i r turn b o u n d up t h e stumps. It is surprising t o see with what dexterity and rapidity surgical operations were p erformed by scores i n the same time really taken up with one case in peaceful regions. When I had finished my professional duties a t one hospital, I would ride to another, first arranging at what hour I would next return. " While there is no historical certainty as to the number of patients that Morton anesthetized during the Civil War, Rene Fulop-Miller states that Morton " . . . was able to s ave more than two thou sand wounded s o l d i e r s fro m the t e r r i b l e agency o f the knife."4 This therapy i s also echoed by Rachel Baker who said that "Following at the edge of battle, Morton gave ether to more than two thousand wounded men."5 There is a clue as to the potential number of patients anesthetized by Morton when he states in the intro duction to his paper that "How little did I think, however, when originally experi menting with the properties of sulfuric ether on my own person, that I should
ever successfully administer it to hun dreds i n one day, and thus prevent an amount of agony fearful to contemplate." At the conclusion of Morton's paper h e proclaims, "For myself, I am repaid for the anxiety and often wretchedness which I have experienced since I first dis covered and introduced the anesthetic qualities of sulfu r i c ether by the con sciousness that I h ave thus been the in strument of averting pain from thousands and thousands of maimed and lacerated heroes, who have calmly rested in a state of anesthesia while undergoing surgical operations, which would otherwise have given them intense torture. They are wor thy of a nation's gratitude-happy I am to have alleviated their sufferings." BIBLIOGRAPHY I. Morton WT G: T he first use of ether as an anesthetic at the battle of the Wilderness in the Civil War. JAMA 42: 1 06 8 - 1 073, 1904. 2. Graham M, Skoch G, Davis WC: Great Battles of the Civil War. Beekman House, New York, 1978, pp 66. 3. McPherson JM: Battle Cry of Freedom. Ballantine, New York, 1 988, pp 904. 4. Fulop-Miller R: Triumph Over Pain. T he Literary Guild of America, New York, 1 93 8 , pp 438. 5 . Baker R : D r. Morton: Pioneer in t h e Use of Ether: Julian Messner, Inc., 1 946, pp 224.
1ST RY
VOLUME 14, NUMBER 1
JANUARY, 1996
William Thomas Green Morton as a Military Anesthetist during the Civil War Maurice S. Albin, M.D., M.Sc.(Anes.) Professor of Anesthesiology and Neurosurgery University of Texas Health Science Center at San Antonio
With the sesquicentennial celebration of the use of sulfuric ether by Morton at the Massachusetts General Hospital (October 1 6, 1 846) shortly upon us, it becomes fitting to examine a little known aspect of this pioneer-the dedicated military Anesthetist. Most of this infor mation concerning Morton's venture into military anesthesia comes to us from a paper published in the JAMA in 1 904 and furnished by his son, William J. Morton, M.D., then residing in New York City.l Apparently, it was written after the battle of the Wilderness in May, 1 864, in which Morton relates his Civil War experiences. It appears that Morton's military anesthesia experiences started dur ing the B attle of Fredericksburg on December 1 3 , 1 862, which was a definitive Confederate victory and which ended on December 15, 1 862, when the Commander-in-Chief of the Union Army, Major General Ambrose Burnside, ordered the Union Army to retreat to the eastern bank of the Rappahanock River. The battle was extraordinarily costly to the Union since their casualties numbered about 12,600 against 5,300 for the Confederates. More than 6,000 Union casualties occurred dur ing the attack on Maryes Heights where the bodies were stacked so high that they had to be trod upon by the attacking Union soldiers 2•3 It appears that Morton was notified by the Surgeon-General of the Union Army that his services would be required prior to the Ba ttle of the Wilderness which commenced on May 4, 1 8 64, and continued through May 6, 1 8 64. This battle resulted in more than 1 7,600 Union casualties and 7,500 Confederate ones. 2•l Shortly thereafter, General Grant turned his Army of the Potomac southeast and tried to outflank the Army of Northern Virginia, commanded by General Robert E. Lee, beginning the battle of S potsylvania which lasted from May 8 through May 1 8 , 1 8 64. This battle caused more than 1 7,500 Union dead and wounded while the Confederates suffered 1 0,000 losses. The combined casualties of the l ast two cited b attles were 35, 100 for the Union and 1 7,500 for the Confederation. 2•l There is certainly no doubt that the talents and services of Morton were needed. In his article, Morton noted that many of the wounded from the B attle of the Wilderness were taken to Hospitals in Fredericksburg, many of which had been churches, and he notes that "one of the principal hospitals was the B aptist Church which was l iterally packed with wounded. The tanks intended for immersion were used as a bathing tub, and the operations were performed in the pastor's small study back of the pulpit." As can be imagined, the transport of the wounded over virtually nonexistent roads brought about u nimaginable suffering to these poor souls. Morton writes that "The ambulances could not have brought one tenth part of them, and the rest were brought in wagons, eleven or twelve miles over the remains of a planked road, worn by war-travel. In places the larger wagons had to be pried out of the deep holes with trimmed trees . . . On such a highway, and in such a manner did these poor fellows, who stretch their hands out of these ambulances and army wagons for tin-cupfuls of water, painfully travel-some with arms off at the shoulders, some with legs off below the knee, some with an arm and leg both off, hundreds shot through the leg or arm, or the breast, some with horrible wounds of the face-even to the loss of the j aw and the destruction of speech-all presenting in the aggregate every Continued on Page 23
F
BULLETIN OF ANESTHESIA HISTORY
.....
for wn tor
e Ie al le as
in �e
'ge
02 Therapy. . . Continued from Page 22 resolved to a d m i n i ster the very e l e m e n t he craved . . . I gener a ted oxygen from chlorate of po tassium and b l a ck oxide of man ganese i n large test tubes over a spirit l amp, and with rubber tub ing I c o n d u c t e d the gas to the b o ttom of a b u cket fil l e d with water which I had placed beside the patient's bed. Then, with a fan, the gas was wafted i nto the patient's face . . . The effects on the respira tion and his color were distinctly appreciated by the par ents and those around the bed side of the young man. I repeated the adm inistration a number of times during the day until i t was n o l o nger n e e d e d . The p a t i e n t
Dr. Morton.
recovered rapidly. R a t h e r to h i s own a s t o n i s h m e n t , George E. Holtzapple, barely out of medi cal school, had disc-o vered the first effec tive treatment for pneumoni a . Until Alexander Fleming's discovery of peni cillin in 1 928, oxygen therapy remained the only effective treatment. Among the thousands of l ives that were saved by Dr. Holtzapple's discovery was that of his own sister, Mrs. Mary S to ver. When she caught pneumonia, he put her into an oxygen tent. During World War I, portable oxygen tents at the front proved effective not only in treating pneumoni a, but also in sav ing victims of poison gas attacks. Today, oxygen therapy is still used to save vic tims of shock, including surgical shock. It is also used to treat heart disease, se-
23
vere migraine, and a variety of other ail ments. Dr. Holtzapple made no money from his discovery, but he received a note of congratulations from King George V of England, and an honorary doctorate from S usqu e h a n n a Univers ity. The d oc to r spent t h e rest of his life practicing medi cine in rural York County, Pennsylvania. He was remembered there as a church going family man who played a variety of musical instruments. Dr. Holtzapple was nearly eighty-four when he died in York, Pennsylvania, on February 22, 1 946. Standing at his bed side during the final days was Fred Gable, aged seventy-seve n . Fred lived to b e ninety-one. He died i n 1 960 a t the Lutheran Home for the Aged in Wash ington, D . C .
. . Continued from Page 1
possible variety of gunshot wound . . . " Morton also speaks of the wounded soldiers going to the rear area and says "it is the most sickening sight of the war, this tide of the wounded flowing back. One has a shattered arm, and the sling in which h e carried it is the same bloody rag the surgeon gave him the d ay of the battle; another has his head seamed and bandaged so you can scarcely see it, as he weaves like a drunken man as he drags along through the hot sun. . . " Morton describes h i s involvement a s an anesthetist a n d t h e organization of the triage system and the field hospital ser vice, put i n place by the Medical D irec tor of the Army of the Potomac, Major Jonathan Letterman. Morton states that "On S aturday morning, May 1 4, I was awakened by the booming of cannon and learned that the enemy were endeavor ing to regain their lost position . . . On the arrival of a train of ambulances at a field hospital the wounds were h astily examined, and those who could bear the j ou r n e y w e r e s e n t a t o n c e t o Fredericksburg. The nature of the opera tions to be performed on the others was then decided on and noted on a bit of paper pinned to the pillow or blanket un der each patient's head. When this had
been done I prepared the patients for the
knife,producing perfect anesthesia in an av erage time of 3 minutes [emphasis MSA],
and the operators followed, performing operations with dexterous skill, while the dressers in t h e i r turn b o u n d up t h e stumps. It is surprising t o see with what dexterity and rapidity surgical operations were p erformed by scores i n the same time really taken up with one case in peaceful regions. When I had finished my professional duties a t one hospital, I would ride to another, first arranging at what hour I would next return. " While there is no historical certainty as to the number of patients that Morton anesthetized during the Civil War, Rene Fulop-Miller states that Morton " . . . was able to s ave more than two thou sand wounded s o l d i e r s fro m the t e r r i b l e agency o f the knife."4 This therapy i s also echoed by Rachel Baker who said that "Following at the edge of battle, Morton gave ether to more than two thousand wounded men."5 There is a clue as to the potential number of patients anesthetized by Morton when he states in the intro duction to his paper that "How little did I think, however, when originally experi menting with the properties of sulfuric ether on my own person, that I should
ever successfully administer it to hun dreds i n one day, and thus prevent an amount of agony fearful to contemplate." At the conclusion of Morton's paper h e proclaims, "For myself, I am repaid for the anxiety and often wretchedness which I have experienced since I first dis covered and introduced the anesthetic qualities of sulfu r i c ether by the con sciousness that I h ave thus been the in strument of averting pain from thousands and thousands of maimed and lacerated heroes, who have calmly rested in a state of anesthesia while undergoing surgical operations, which would otherwise have given them intense torture. They are wor thy of a nation's gratitude-happy I am to have alleviated their sufferings." BIBLIOGRAPHY I. Morton WT G: T he first use of ether as an anesthetic at the battle of the Wilderness in the Civil War. JAMA 42: 1 06 8 - 1 073, 1904. 2. Graham M, Skoch G, Davis WC: Great Battles of the Civil War. Beekman House, New York, 1978, pp 66. 3. McPherson JM: Battle Cry of Freedom. Ballantine, New York, 1 988, pp 904. 4. Fulop-Miller R: Triumph Over Pain. T he Literary Guild of America, New York, 1 93 8 , pp 438. 5 . Baker R : D r. Morton: Pioneer in t h e Use of Ether: Julian Messner, Inc., 1 946, pp 224.