“Comercio del Plata” [16] of Montevideo reported Simpson’s successful use of chloroform. The French pharmacist Francisco Thibalier in Montevideo then distilled ethyl alcohol over calcium chloride to obtain chloroform. On 11 February 1848, in the “Charity Hospital” of Montevideo, Fermín Ferreira applied a sponge soaked with this chloroform to Jose Silva, and then operated to correct his phimosis. On 17 February, using chloroform for anesthesia, Bartolomé Odiccini operated on two soldiers. Subsequently, Brunel, with the same anesthetic, repaired a strangulated hernia in a 52 year old patient, and reported no complications.

It seems likely that the substance prepared by Thibalier was, in fact, chloroform, but this is not certain. In 1853, pharmacy student Mario Isola, at a meeting in the Society of Medicine of Montevideo, introduced chloroform prepared according to the standards set by “Codex Medicamentorum Gallicus”, edition 1851.

In 1848, John Mackenna in the “British Medical Dispensary” (from 1853 called theBritish Hospital of Buenos Aires) operated on a female patient for osteoclasia of the femur anesthetized with chloroform. On Saturday, 8 July 1848 the “British Packet and Argentine News” [17] in Buenos Aires, reported the event without referring to the day or the month of the surgical procedure.

In Valparaiso, in October 1848, Francisco Javier Villanueva administered chloroform for an upper limb amputation. The 23 October issue of “El Mercurio”[18] of Valparaiso, reported:

“Brilliant success of chloroform…A 90 year old woman had been taken to the hospital with a shattered arm caused by a fall. Dr. Villanueva decided to make the amputation of the arm with the aid of chloroform, which took effect without the patient feeling any pain; today, 15 days later, she is almost fully recovered.”

Chloroform was used on a recently delivered mother by Rodrigo de Bivar [11] in Rio de Janeiro in 1848. There is no reference as to the day or month.

In 1849, Antonio Reyes successfully resected a breast tumor with the patient anesthetized with chloroform [19]. In Bogotá, in 1864, chloroform was used to perform the first resection of an ovary, while in Medellín, it was first used in 1880.

Eliseo Acosta [14] used chloroform in Caracas in 1848, and Guillermo Michelena subsequently enhanced its popularity. In 1856, Carlos du Villards bought the first apparatus for administration of chloroform (an accurate description of the apparatus is not available).

Chloroform was used during the War of the Triple Alliance (1864–1870, Argentina, Brazil and Uruguay against Paraguay). Sanabria Ortiz wrote that “Anesthesia, that had already begun to be used during the War of the Triple Alliance, was popularized”. Apparently, chloroform came late to Paraguay.

Ettine Gayraud and Dominique Domec wrote in 1873 about “the professionalism of surgical procedures in Quito since the early usage of chloroform anesthesia. In those years, alcohol (liquor) and exotic weeds were used for surgery” [20]. Domec, an anesthesiologist from “San Eloy Hospital” of Montpellier, appointed as Professor of Anatomy and Anesthesia, introduced chloroform in 1873, at the “Hospital San Juan de Dios” in Quito, applying it with a handkerchief or dressing.

In 1870, Alejandro Shibbeye, a Swedish national, used “the nitrous oxide anesthetic, as advised by its discoverer” [24], in Quito. The identity of the “discoverer” is unclear, but the author of the reference (Oswaldo Pinto) studied under Rovenstine in 1960–2.

The dental surgeon, Louis Ernest [15], introduced nitrous oxide on 16 June 1871 in Buenos Aires, performing practical demonstrations of dental extractions before prestigious physicians. Ernest volunteered to take “laughing gas” (sic) administered by his colleague, Winkelman, a surgeon in the War of Paraguay. On 18 May 1874, the “Buenos Aires Medical Surgical Journal” called attention to deaths from the use of 100% “laughing gas” in dental extractions.

In 1905, Nicasio Etchepareborda spoke on “Short general anesthesia” at the School of Medicine of Buenos Aires, saying that nitrous oxide “is the safest of all anesthetics” according to statistics published in the US and England, and that accidents occurred in Argentina because the gas was “handled by incompetent hands”. He also suggested the addition of “small amounts of oxygen.”

Lázaro Restrepo [6] used nitrous oxide in 1885, in the city of Antioquía.

According to Aureliano Oyarzún [18], some American dentists used “nitrous oxide or laughing gas” in Chile before 1890.

Nitrous oxide use began in the early twentieth century, although only in rare cases. Pedro Cantonet, José Bado and Manuel Herrera performed the first documented anesthesia procedures with it in 1926.

In Paraguay, nitrous oxide use was sporadic in the early twentieth century.

Beltrán Hurtado [14] delivered nitrous oxide in 1917 at the “Hospital Vargas” de Caracas.

In 1918, Novoa presented his doctoral thesis “The N ₂ O narcosis”. The author wrote that Graña administered most of the anesthetics, using an apparatus that delivered nitrous oxide, oxygen and ether. He said that nitrous oxide use should be reserved for short operations.

Using Desmarest’s device, Leonido Ribeiro introduced nitrous oxide anesthesia in Rio de Janeiro in 1926, and then in Sao Paulo. In 1930, Pedro Netto of Sao Paulo presented his doctoral thesis “Anestesia Geral pelo Protóxido de Azoto”, the thesis becoming the first paper on anesthesia to be awarded a prize in Brazil.

The first spinal anesthetics were performed in the late nineteenth century, in Brazil and Uruguay, but only in the twentieth century was this method fine-tuned and accepted worldwide. August Bier performed the first spinal anesthetic, anesthetizing his graduate student on 16 Aug 1898, in Kiel, Germany, injecting 3 ml of 0.5% cocaine. Bier should have received the first “spinal”, but after introducing the needle, and while spinal fluid gushed forth, the graduate student found that the syringe containing cocaine didn’t fit the hub of the needle. Bier got a spinal headache, and the graduate student got the spinal anesthetic. Spinal anesthesia quickly spread throughout South America. Favoring its application were its low cost and the flexibility it permitted the surgeon who could (sequentially) give the anesthetic and perform the surgery. Spinal anesthesia also did not impose some of the dangers of general anesthesia, such as hypoxia and hepatotoxicity.