A couple of weeks ago, whilst looking through stores and collections at the museum, the Curatorial Team came across an interesting box inscribed with the name “Sodium Thiopenal”. Knowing about my interest in all things anaesthetic, they asked me to share its varied history. Below are some facts about this illustrious drug.
The drug Sodium Thiopental, marketed as “Penthotal”, was discovered in the early 1930s by Abbott Laboratories. It was originally intended to be a new pain killing medicine but showed no results in initial testing. The first
human tests on the properties of the new drug commenced in 1934 under Dr Ralph Waters. He found that it had some short-term anaesthetic properties, but again provided no pain relief. Soon afterwards, his colleague Dr John Lundy, started clinical trials on the request of Abbott and the drug was then manufactured until 2004.
When Sodium Thiopental is mentioned, there are usually two things, with which it is associated. The first is that it caused larger numbers of fatalities at Pearl Harbor than the Japanese surprise attack itself, and the other, for avid lovers of spy and crime fiction, is its use as a truth serum. So, what can we say about these and other uses ?
Initially, the trials in the mid 1930s indicated the ability to provide for short term anaesthesia. An injection of the drug almost immediately provides a 60% mix for maximal anaesthesia. This wears off within 5-10 minutes, and therefore makes it the ideal agent during childbirth or when inducing intubation of the airways to deliver a stronger anaesthetic such as ether.
Initially used by doctors during childbirth, it quickly became apparent, that the women continued to discourse freely, while under the influence. They also responded to questions put to them. Clinicians noted uninhibited reactions to questions, free from outside considerations and influences, and it was logically assumed that they spoke the truth.
News about this particular effect of this drug reached psychoanalysts, who were looking for a way to help the severely shell-shocked combatants from the two World Wars. Many of the combatants had great difficulty speaking, if they were able to do so at all. Earlier barbiturates had been used in the same way to reduce anxieties and enable the soldiers to speak about their experiences and, ultimately, heal them.
This knowledge then passed on to the police, who quickly saw the potential use of the truth serum in questioning suspects and prisoners. As with the women during childbirth, the prisoners of their situation was supposed to be nullified, so that they would answer questions without making up their own responses. Writers of spy and detective fiction also incorporated this new technique into their work and spread the word to the general public.
It sounded logical that a person who was unaware of their surroundings would obviously tell nothing but the truth. And many convictions were made using this method in the US in the early years. Other people looking for the truth, psychiatrists, were soon including truth serums into their practice as well. For them, the potential of unlocking the truth of a patient’s past was the aim and patients were ‘led back in time’ to confront traumas of the past.
A changing point came in 1973 with the publication of the ‘Sybil’ case, she had been a psychiatric patient since the 1950s onwards, whose diagnosis had established multiple personalities syndrome. Sybil (her real name was Shirley Mason), had been injected with Thiopental after she had presented multiple personalities in her therapy sessions. Reviewing the case later from recordings and transcripts kept by her therapist, it became evident that the psychoanalyst had led her to create ‘false memories’ and she had obliged and confessed that she had made up all of the other personalities and events. She also had exhibited clear addiction symptoms to Thiopental, but the therapy injections had continued nonetheless.
With the publication of the book “Sybil”, named after one of the personalities she presented, Mason was eventually ‘cured’ in 1965. She went into hiding and avoided all friends and family before she died in the late 1980s.
Apart from the use as a truth serum, the most repeated ‘fact’ about the drug sodium thiopental is the high number of fatalities it caused in the
Hawaiian port of Pearl Harbor after the Japanese surprise attack on 7 December 1941. On that day, there had been 2403 casualties and 1178 wounded amongst US servicemen during and after the attack. 1227 men alone had died on the USS Arizona.
Due to lack of details about medical treatment being made available by the US Government, these numbers in themselves were the main point of discussion through the decades, and the relatively new drug Pentothal was presented as the ultimate reason for the large numbers of fatalities alone. It had only been demonstrated to the Army and Navy medical personnel in the days shortly before the attack, and from that point the warning to medical students from the 1950s all the way to the 1990s was:
[…] if you go on to do anaesthesia, you must use this thiopental with great care and diligence because the Yanks killed more of their own at Pearl Harbor than did the Japanese in their attack […]
Only with the release of documents in 1995 under the Freedom of Information Act was it possible to look at the pure facts and first-hand accounts. A surgeon at one of the army hospitals, which had admitted 160 wounded within 2-3 hours of the start of the attacks, recounted many years later:
Anaesthesia was a problem. Some of the debridements were done under local anaesthesia. But general anaesthesia was needed in many cases and the only nurse anaesthetist was busy in the operating room. […] We had just been issued a new drug called Pentothal which could be given IV [intravenously] for anaesthesia. We got a box, read the directions and […] used it on many cases over the next 48 hours with excellent results.
With this as with other reports, there is no mention of any excess in mortality or death related to the use of the drug. Civilian hospitals, which did not come under the restrictions of issuing statements but also treated many attack related casualties, reported in 1942 that ether anaesthesia by the drop method, lends itself well to this type of surgery. It has the advantage of safety and in addition, […] it may be given by those with little training.
Looking at the files released 50 years after the event, it becomes clear that the stories about the large mortality due to barbiturates were nothing but exaggerated scare stories. Most patients had received the safer ether anaesthesia and compared to the mortality in other campaigns in World War II, Pearl Harbor numbers did not vary widely from expected mortality rates. The lack of essentials and trained anaesthetists to deal with the numbers of patients in a relatively short period of time were probably a much bigger factor.
The property of fatal overdoses made Thiopental a preferred drug not only for vets to euthanise animals but has also been one of the three agents used in the US for lethal injection on death row.
In 2009, Ohio was the first state to use Thiopental as a single-dose injection for the purposes of execution. Others followed in the two years until 2011, when the European Union extended trade restrictions on the drug under the ‘European Union Torture Regulation’, which bans the export of medical products, which can be used for capital punishment. The manufacturer in the US had already ceased production in 2004.
Both of the rather colourful, if fanciful, stories regarding Sodium Thiopental and its part in truth and death have been over the years explained and exposed as just that… stories! Barbiturates are nowadays mainly used as an induction drug for veterinary anaesthesia.
Bennetts F.E. 1990. Chicago to Pearl Harbor. History of Anaesthesia Proceedings 8a, p8-15.
Bennetts F.E. 1995. Thiopentone anaesthesia at Pearl Harbor. Brit. Journal of Anaesthesia 75, p366-368.
Inglis-Arkell Esther. 2012. What truths does “truth serum” sodium pentothal actually reveal? https://io9.gizmodo.com/what-t…
Nathan Debbie. Free Press 2013. Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case. Scene from True Lies: BBC 2013. Can a drug make you tell the truth. https://www.bbc.co.uk/news/mag…
To cite this post : Iris Millis, “The Truth and Pearl Harbor – Sodium Thiopenal”, Museum Highlights (blog on oldoperatingtheatre.com), May 14, 2019.
Iris Millis is former a museum officer at the Old Operating Theatre Museum and Herb Garret. She has previously worked for the Anaesthesia Museum and Bodyworlds. She is member of the History of Anaesthesia Society and the John Snow Society. Follow her on Twitter, @historical_iris.