Soldiers historically "bit the bullet" as a way to cope with extreme pain, particularly during surgery or battlefield wounds, as the act of biting down on something hard would distract them from the intense sensation, essentially providing a psychological coping mechanism; this practice is most commonly associated with the American Civil War era where medical practices were often brutal and without anesthesia.
The notion of the metaphor ”biting the bullet” gaining popularity during the American Civil War is well established anecdotally but, as a common physical practice for patients undergoing surgery without anaesthetic, the evidence is scant.
Anaesthesia using ether and chloroform was introduced in 1846/47 and ether was widely issued to U.S. military surgeons as early as 1849 – well before the US Civil War began. Chloroform was the preferred anaesthetic because it only required small quantities, took effect more quickly, and (unlike ether) was non-flammable.
U.S. Army surgeon W.W. Keen described an incident after the Battle of Gettysburg: “
The only available light was five candles…suddenly the ether flashed afire, the etherizer flung the glass bottle of ether…in one direction and the blazing cone fortunately in another direction. We narrowly escaped a serious conflagration.”
According to the series of journals “The Medical and Surgical History of the War of the Rebellion” published not long after the war, most procedures were performed using chloroform, with about 14 percent using ether, and 9 percent using an ether-chloroform mix. Chloroform was almost uniformly used in field hospitals, while ether was more frequently used in general hospitals far behind the lines.
Over the course of the Civil War, an estimated 476,000 soldiers were wounded by bullets, artillery shrapnel, or sabers and bayonets with various degrees of severity and consequential need for surgery. The most common wounds suffered were from musket fire. Around 60,000 operations were amputations. The medical director of the Army of the Potomac, Dr. Jonathan Letterman, was well aware of the criticisms of ‘butcher’ surgeons in the field and wrote in his report after the Battle of Antietam:
“
The surgery of these battlefields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.”
When amputation was necessary, the limb was not simply “chopped off” as commonly believed. The procedure was sophisticated, and like most surgical procedures over the course of the war, were conducted with patients under anaesthesia in the form of either chloroform or ether.
Around 125,000 surgeries involving general anaesthesia were performed on both sides during the war, and there was little difference in attitudes or availability between the two belligerents. The journals record at least 80,000 surgeries performed by Union doctors using some form of anaesthetic, but only 254 without. Confederate records are less complete because most of them were burned at Richmond after the war. Nevertheless, anaesthesia was also a priority for Confederate surgeons and several laboratories were constructed for chloroform and ether production. Dr. Julian Chisolm’s laboratory in Columbia, S.C., was considered so important that he “
asked for and received the single-largest Confederate warrant for medical supplies, more than $850,000, issued on April 13, 1864” despite the Confederacy being cash-strapped.
It’s known that some doctors during the war did not use anaesthesia for reasons unrelated to its availability; they feared that it might induce additional hemorrhaging, cause blood-poisoning, and slow recovery. Apparently, patients were sometimes even offered the choice of with or without anaesthetic. Recorded instances where anaesthetics were unavailable are rare, as are actual reports of bullet-biting.
The origins of the phrase itself are unclear, but a variant of it is recorded in Francis Grose’s 1796 “Classical Dictionary of the Vulgar Tongue” within the definition for a “nightingale”:
Nightingale. A soldier who, as the term is, sings out at the halberts [makeshift whipping posts made from poles tied together]. It is a point of honour in some regiments, among the grenadiers, never to cry out, or become nightingales, whilst under the discipline of the cat of nine tails; to avoid which, they chew a bullet.
References:
Gary Martin on the ‘Phrase Finder’ website.
‘Amputations and the Civil War: Surgery in the Civil War Era’ by Paige Gibbons Backus on the ‘American Battlefield Trust’ website.
Kyle Dalton, National Museum of Civil War Medicine membership and development coordinator on the ‘historynet’ website.
