{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T15:36:51Z","timestamp":1765294611609,"version":"3.46.0"},"reference-count":15,"publisher":"Walter de Gruyter GmbH","issue":"4","content-domain":{"domain":["scandinavianjournalpain.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_j.sjpain.2013.07.028_s_001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The United States Civil War (1861\u20131865) pitted the more populous industrialized North (Union) against the mainly agricultural slaveholding South (Confederacy). This conflict cost an enormous number of lives, with recent estimates mentioning a total mortality greater than 700,000 combatants [1]. Although sulfuric ether (ETH) and chloroform (CHL) were available since Morton\u2019s use of the former in 1846 and the employment of the latter in 1847, and even though inhalational agents were used in Crimean war (1853\u20131856) and the Mexican-American War (1846\u20131848), the United States Civil War gave military surgeons on both sides the opportunity to experience the use of these two agents because of the large number of casualties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2013.07.028_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Research of historic archives illustrates the dramatic control of surgical pain made possible with introduction of two general anesthetic and analgesic drugs in 1846 and 1847.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2013.07.028_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An appreciation of the importance of anesthesia during surgical procedures can be noted in the poignant and at times hair raising cases of two left arm amputations carried out under appalling circumstances during the United States Civil War. In the first-case the amputation was delayed for nearly five days after the wounding of Private Winchell who served in an elite sharpshooter brigade and was captured by the Confederate Army during battle. The amputation was performed without anesthesia and the voice of the Private himself narrates his dreadful experience. The postoperative course was incredible as he received no analgesia and survived a delirious comatose state lying on the ground in the intense summer heat.<\/jats:p>\n                    <jats:p>Thomas Jonathan \u201cStonewall\u201d Jackson was a famous ascetic Confederate General who helped defeat the Union forces at the Battle of Chancellorsville on May 2, 1863. In the ensuing near-darkness, Jackson was fired upon by his own friendly troops where he suffered multiple gunshot wounds on his right hand as well as a ball in the upper humerus of the left arm similar to that of Private Winchell. Transported to a field hospital about thirty miles away, the evacuation was carried out under artillery fire and the General dropped from the stretcher at least twice before arriving at the field hospital. There, a team of surgeons operated on \u201cStonewall\u201d, using open drop chloroform, the surgery taking 50 min, anesthesia times of one hour with General Jackson awake and speaking with clarity shortly after the termination of the anesthesia. A brief explanation of the use of anesthetics in the military environment during the Crimean, Mexican American and the United States Civil War is also presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2013.07.028_s_004\">\n                    <jats:title>Conclusion and implications<\/jats:title>\n                    <jats:p>Two case stories illustrate the profound improvement in surgical pain made possible with ether and chloroform only 160 years ago. Surgeons and patients nowadays have no ideas what these most important improvements in modern medicine means, unless \u201creliving\u201d the true hell of pain surgery was before ether and chloroform.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.sjpain.2013.07.028","type":"journal-article","created":{"date-parts":[[2013,9,14]],"date-time":"2013-09-14T03:30:59Z","timestamp":1379129459000},"page":"243-246","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["In praise of anesthesia: Two case studies of pain and suffering during major surgical procedures with and without anesthesia in the United States Civil War-1861\u201365"],"prefix":"10.1515","volume":"4","author":[{"given":"Maurice S.","family":"Albin","sequence":"first","affiliation":[{"name":"David Chestnut, M.D., Section on the History of Anesthesia, Department of Anesthesiology , University of Alabama School of Medicine at Birmingham , JT 845, 619 19th Street South , Birmingham, AL 35294 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2013,10,1]]},"reference":[{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_001","doi-asserted-by":"crossref","unstructured":"Hacker JD. A census-based count of the civil war dead. Civil War Hist 2011;57:307\u201348.","DOI":"10.1353\/cwh.2011.0061"},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_002","doi-asserted-by":"crossref","unstructured":"Bigelow HJ. In sensibility during surgical operations produced by inhalation. Boston Med Surg J (later = N Eng J Med) 1846;35:309\u201317.","DOI":"10.1056\/NEJM184611180351601"},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_003","doi-asserted-by":"crossref","unstructured":"Simpson JY. On a new anaesthetic agent more efficient than sulfuric ether. Lancet 1847;2:549\u201350.","DOI":"10.1016\/S0140-6736(00)63271-3"},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_004","unstructured":"Long CW. An account of the first use of sulfuric ether by inhalation as an anaesthetic in surgical operations. Southern Med Surg J 1849;5:5\u201313."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_005","unstructured":"Sims JM. The discovery of anesthesia. Va Med Monthly 1877;4:19\u201341."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_006","doi-asserted-by":"crossref","unstructured":"Aldrete JA, Marron GA, Wright AJ. The first administration of anesthesia in military surgery. On occasion of the Mexican-American War. Anesthesiology 1984;61:585\u20138.","DOI":"10.1097\/00000542-198411000-00019"},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_007","unstructured":"MacLeod GHB. Notes on the surgery of the war in the Crimea with remarks on the treatment of gunshot wounds. Philadelphia: JB Lippincott and Co; 1862."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_008","unstructured":"Baudens L La. Guerre de Crime\u00e9, les Campements, les Abris, les Ambulances, et les Hospitaux. Paris: Germer Balli\u00e9re; 1858."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_009","unstructured":"Albin MS. The use of anesthetic agents during the Civil War, 1861\u20131865.Pharm Hist 2000;40:99\u2013114."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_010","unstructured":"The Medical and Surgical History of the War of the Rebellion, Prepared under the direction of Joseph K. Barnes, Surgeon General United States Army, by George A. Otis, Surgeon, United States Army, and D. L. Huntington, Surgeon, United States Army (Surgical volume, 3 parts); J.J. Woodward, Surgeon, United States Army and Charles Smart, Surgeon, United States Army (Medical Volume, 3 Parts), Second Issue. Washington, DC: Government Printing Office; 1883."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_011","unstructured":"Livermore TL. Numbers and Losses in the Civil War in America: 1861\u20131865, reproduction from the original printed in 1900. Civil War Centennial Series. Bloomington: Indiana University Press; 1957."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_012","unstructured":"Pernick MS. A calculus of suffering: pain, professionalism and anesthesia in nineteenth century America. New York: Columbia University Press; 1985."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_013","doi-asserted-by":"crossref","unstructured":"Porter JB. Medical and surgical notes of campaigns in the war with Mexico during the years 1845,1846, 1847 and 1848.Am J Med Sci 1852;47:2\u201330.","DOI":"10.1097\/00000441-185207000-00001"},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_014","unstructured":"Stevens CA. Wounded and a prisoner. In: Berdan\u2019s United States Sharpshooters in the Army of the Potomac, 1861\u20131865. St. Paul: Price McGill Co; 1892."},{"key":"2025120909544509345_j_j.sjpain.2013.07.028_ref_015","doi-asserted-by":"crossref","unstructured":"Albin MS. The wounding, amputation and death of Thomas Jonathan Stonewall Jackson \u2013 some medical and historical insights. Bull Anes Hist 2001;19:1\u201315.","DOI":"10.1016\/S1522-8649(01)50046-3"}],"container-title":["Scandinavian Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/sjpain\/4\/4\/article-p243.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886013001006?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/api.elsevier.com\/content\/article\/PII:S1877886013001006?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2013.07.028\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2013.07.028\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T11:45:10Z","timestamp":1765280710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1016\/j.sjpain.2013.07.028\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,1]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2013,10,1]]},"published-print":{"date-parts":[[2013,10,1]]}},"alternative-id":["10.1016\/j.sjpain.2013.07.028"],"URL":"https:\/\/doi.org\/10.1016\/j.sjpain.2013.07.028","relation":{},"ISSN":["1877-8860","1877-8879"],"issn-type":[{"type":"print","value":"1877-8860"},{"type":"electronic","value":"1877-8879"}],"subject":[],"published":{"date-parts":[[2013,10,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"In praise of anesthesia: Two case studies of pain and suffering during major surgical procedures with and without anesthesia in the United States Civil War-1861\u201365","name":"articletitle","label":"Article Title"},{"value":"Scandinavian Journal of Pain","name":"journaltitle","label":"Journal Title"},{"value":"http:\/\/dx.doi.org\/10.1016\/j.sjpain.2013.07.028","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"http:\/\/dx.doi.org\/10.1016\/j.sjpain.2013.07.027","name":"associatedlink","label":"CrossRef DOI link to the associated document"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2013 Scandinavian Association for the Study of Pain. 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