Wednesday, April 13, 2011

More on Civil War Anesthesia! (aka Thank God for Dr. Squibb!)

Even though it was posted only little over a month ago, my column on anesthesia in the Civil War (here) is already one of the all-time popular posts on this blog...for those of you who are curious, according to Blogger's stats, the run-down is:

#1 - Medical Department #30 - Civil War Surgical Photography - Oct 2009

#2 - Medical Department #18 - Lee's Health at Gettysburg - June 2008
#3- Medical Department #7 - Quinine Substitutes in the Confederacy - Sept 2007
#4- Medical Department #4 - Civil War Pharmacy - Jun 2007
#5 - Medical Department #38 - Civil War Anesthesia - March 2011

Well, you know what they say: what's better than ONE post on Civil War anesthesia? TWO posts!

Below is an extended excerpt from my first book, Lincoln's Labels: America's Best Known Brands and the Civil War
(Edinborough Press, 2008) explains the VERY important role that Dr. Edward R. Squibb played in perfecting the safe manufacture of effective ether and chloroform just before the Civil War. It includes some images and links not included in the book.


When Charles Darwin was asked his opinion on the most important discovery of the nineteenth century, he answered, “painless surgery.” Although physicians and dentists had privately used ether with patients in the early 1840s, it was October 1846 before its value in surgery was made public in a well-attended demonstration hosted by Dr. William T. G. Morton at Massachusetts General Hospital. Still, surgeons hesitated to use ether (as well as chloroform, introduced at about the same time) because the preparations then available varied so much in quality, and their action was so uncertain that they proved more of a risk than a benefit. In addition, ether’s manufacture was very dangerous as the volatile and highly inflammable liquid was prepared in crude stills over an open fire.(1)

Edward R. Squibb did not invent anesthesia, but he is justly remembered for his production of safe, standard, and effective anesthetics by equally safe and effective manufacture. Ether was the foundation of Squibb’s business and he established a standard for quality that stood well after his passing. It is largely to Squibb’s credit that the Union Army had a ready and reliable supply of ether and chloroform for its surgeons to use (and perhaps Confederate surgeons, also; one historian claimed that “Abraham Lincoln himself chose to overlook the smuggling of Squibb ether to the South”).(2)

Squibb was certainly aware of the Jefferson Medical College faculty’s first uses of ether in 1846 and 1847. In 1851 — on leave from the Nav
y — he took three months of refresher courses at Jefferson (“rubbing up,” it was called) with an eye towards promotion and a raise. While there, he filled his journal with careful notes about the chemistry and preparation of ether and his impressions of its use, including an operation on a fifty-year old man whose swollen leg required amputation:

“The patient was not easily etherized, but was finally brought under the full effect and kept so during the entire operation. . . . The double-flap operation was performed just above the knee, the bone being sawed through at about its middle. . . . At the end, just before the dressing, the patient was asked if he felt the operation and replied that he did not know it was done . . . The operation was very well and prettily and quickly done. . . . A large audience and one case of fainting.”(3)

Squibb’s experiences during the “rubbing up” at Jefferson had also shown him that the effect of ether was quite variable, even on patients of similar age and stature. Now at his laboratory at the Brooklyn Naval Hospital, he had an opportunity to discover why this was so. Squibb bought six samples of ether on the market and after putting them to careful tests of purity, color, density, and clarity, found them to be widely variable. He published his results and conclusion — that the doubtful reliability of ether in surgery was due to its careless manufacture from ingredients of dubious quality — and worried that the poor ether being used brought to surgery “an uncertainty which does not belong to it”; rather, the discredit “justly belong[ed] to the preparation which [the surgeon] employs.”(4)

Squibb then set his mind to discovering a method of safely manufacturing ether of standard strength and purity in a safe manner. After well over a year of experiments, and nearly two dozen attempts at labyrinths of pipes, flasks, and boilers, he developed a process using steam (rather than an open fire) as a heat source that resulted in very pure ether and a much less dangerous procedure. Unwilling to capitalize on his discovery personally (Morton, who had received a patent in 1846, claimed a 10% royalty on each use of ether for anesthesia), Squibb published in 1856 a full account of his process with drawings, directions, formulas, and costs.

After his success with ether, Squibb then turned to perfecting the manufacture of chloroform, and published his results of equal success a year later. His ether and chloroform were put to good use in the Navy; Squibb wrote that of the nearly 200 pounds he had manufactured for the Navy, most of it had been used and “as yet without a single reported case of bad results.” Others thought as highly when Squibb made the anesthetics for profit. Dr. Valentine Mott, a well-respected surgeon of the era, wrote that in his practice, “I have been in the habit of using the Scotch Chloroform of Duncan, Flockhart, & Co., of Edinburgh, but have also employed that of Dr. Squibb, of Brooklyn, and with pleasure commend the latter for its purity and reliability.”(5)

Ether and chloroform were used to great effect in the Civil War and Union authorities purchased many tons of each. Official records from the war suggest that anesthesia was employed in no fewer than 80,000 cases. As impressive as the widespread use of ether and chloroform during the war is their safety record; fewer than fifty deaths were attributed to anesthesia in the tens of thousands of cases in which it was used.

Morton — whose demonstration in 1846 was the genesis of the widespread use of anesthesia — did not make a fortune from royalties. Squibb — who never sought royalties — prospered nonetheless by selling reliable and safe products. There is no evidence that Squibb ever begrudged Morton his legal right to a fortune; he carried on a correspondence with Morton when he was still at the Navy laboratory. There is no doubt that both men’s inventions did great good during the Civil War. In 1862, Morton joined the Union Army as a volunteer surgeon and performed valuable service as an anesthesiologist (almost certainly using Squibb’s products). Of his experience at the Battle of the Wilderness in May 1864, which produced more than 30,000 casualties on the Union side alone, Morton gave witness to Darwin’s declaration that “painless surgery” was the great discovery of the nineteenth century, “How little did I think . . . when originally experimenting with the properties of sulfuric ether on my own person, that I should ever successfully administer it to hundreds iin one day, and thus prevent an amount of agony fearful to contemplate.”(6)


(1) Stearns, F. P., Cambridge Sketches. (Philadelphia: J.B. Lippincott Company, 1905), p. 309.
(2) Wickware, F. S., The House of Squibb. (New York: E. R. Squibb & Sons, 1945), p. 12.
(3) Blochman, L. G,. Doctor Squibb: The Life and Times of a Rugged Idealist. (New York: Simon and Schuster, 1958), p. 43.
(4) Squibb, E. R. and K. Florey (ed.) The Collected Papers of Edward Robinson Squibb, M.D., 1819-1900, 2 vols. (Princeton, N.J.: Squibb Corp., 1988), p. 304.
(5) “as yet without . . . ” in Squibb, Papers, p. 110; “I have been in . . . ” in Mott, V. Pain and Anæsthetics: An Essay Introductory to a Series of Surgical and Medical Monographs. (Washington: Government Printing Office, 1862),p. 15.
(6), Albin, M. S. “The Use of Anesthetics During the Civil War, 1861-1865.” Pharmacy in History, Vol. 42. Nos. 3 and 4, 2000, 99-114.

You can read MUCH MORE about Dr. Squibb and the Civil War in Lincoln's Labels!

1 comment:

Linda said...

Thank you SO much for sharing this--you write medical issues in such a way that I can learn and yet not get the queasy sensation I sometimes experience when reading of other medical accomplishments.

Your blog posts are always both entertaining and informative; thank you for covering Civil War topics without bias toward either side.