ADNAN
A. AL-MAZROOA and RABIE E. ABDEL-HALIM
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The
History of Anaesthesia
Edited by:
Richard S. Atkinson
And Thomas B. Boulton
International
Congress and Symposium Series Number 134, 1989, pp 46-48
Royal
Society of Medicine Services
And
The
Parthenon Publishing Group
International
Publishers In Science & Technology
Caslerton Hall, Camforth,
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Pain is a
subjective experience which requires the presence of consciousness. Over the
ages there has been a demand for methods of relief. In this paper, we present a
brief report about the use of narcotics for pain relief from antiquity up to
the Renaissance.
Greek
and Roman medicine
Though Celsus (I), in the 1st Century,
used opium and mandrake for pain relief, Galen in the 2nd Century (as stated by Cumston (2) and De Moulin (3)) recommended great care with the use of powerful narcotics such as opium, considering
it a dangerous drug. According to Campbell (4) and Cumston
(2), Galen was looked upon as one of the great physicians. He summarized the
knowledge accumulated in Greek medicine up to his time and studied every aspect
of medicine. In cases of colic or other very violent pains, he used only opium.
After Galen, Greek medicine produced four writers who did not
contribute any advancement. Their works mainly consisted of quotations from
Hippocrates and Galen (4). As a consequence, the strong narcotic drug mandrake used
by Celsus (I) seems to have fallen into neglect;
confirmation of this is that Paulus (5) in the 7th
Century, who is regarded as having summed up all medical knowledge accumulated
up to his time, did not use it in his trochisci as an
anodyne.
Paulus did not give the toxic dose or details of the specific actions of
either mandrake or opium. It seems that there was no standardization or
regulation of dosage (6,7). It was therefore
impossible to standardize the results (6,8,9) and,
attempts at the conquest of pain were sporadic (10).
The Middle Ages
In the
Middle Ages Christian Europe was in a state of intellectual stagnation
(2.4,7,11,12) and the theological doctrine that pain serves God's purpose and
must not be alleviated militated against the improvement in methods of narcosis
(4,6, 7). Nuland (7) points out that the Middle Ages
in
Therefore, not only Avicenna (16) but also Al-Razi
(17), Al Baghdady (I8) and Ibn
El Kuff (19), paid great attention to the phenomenon of
pain (3). They attributed it not only to a breach of continuity, as stated by
Galen, but also to a sudden change of temperament (by only heat, cold or
dryness) with or without abnormal humours. Hence, for
pain relief, they stressed the treatment of the underlying cause and they
subsequently developed a large number of analgesics with variable modes of
action. The anaesthetics they described included a
wide range of medical plants as well as ice or very cold iced water as an efficient
and safe mode of local anaesthesia even though there
might be an increase in the pain at the beginning. Refrigeration anaesthesia which is considered by some to be a modern
discovery, thus, had
its origin in the medicine of the past.
They attributed the anaesthetic action
of the various medical plants used to a specific poisonous property of variable
strength, and thus according to Avicenna (16), opium is the most powerful, then
mandrake, papaveris, henbane or hyocyamus,
hemlock, solanum and wild lettuce. These drugs,
especially opium, were used as local anaesthetics in
dental cases, earache, eye pain and joint pain (especially in gout).
In dentistry, they used opium, mandrake root or henbane juice in
the form of pastes, patches or fillings. Gargles from decoctions of mandrake root,
henbane root or seeds or the root of solanum were
also used.
Opium drops in rose oil, infusion of root of solanum,
decoction of papaveris, oil or juice of henbane and
angelica juice were used for earache. The relief of eye pains was achieved by
either using dressings from mandrake leaves or mixing the eye medicines with
mandrake tears or juice of hemlock. Embrocations of
the juice of henbane leaves or seeds were also used on the eye and, for joint
pains, dressings from mandrake leaves or embrocations
from opium, hemlock, henbane or cannabis.
In addition. because it was noticed that severe pain
may lead to death, the soporific action of
these drugs was employed especially pre-operatively in the cases of
amputation, cautery, circumcision and lacerations.
They were administered by ingestion, inhalation or rectally. Infusions of solanum, cannabis, opium and mandrake were given orally or
rectally on a plug which has to be changed hourly. Opium, mandrake and henbane
were also used by inhalation in the form of odorants.
The wild lettuce has a mild soporific effect. It was used either
fresh or boiled as an adjuvant to any of the previous medications or alone in
cases of insomnia.
These physicians not only determined the required dose in each
drug precisely but also were able to fix the length of time which the anaesthesia was to last with great precision. Avicenna for
example, gave the dose of one 'mithkal' of mandrake
for 3-4 hours of general anaesthesia.
Unlike Paulus
(5). Avicenna (16), AI Razi
(17). Al Baghdady (18), Ibn
EI-Kuff (19) and Ibn El Bitar (20), in the light of their own experiments and
observations, described the general and special botanical charactcrs
of the plants in detail as well as indicating their habitats and what was best
selected from each. They also specified methods for obtaining the active
ingredients whether as juice or in the various medical forms that can be
prepared as infusions, decoctions or dressings.
They also described the specific actions and side effects on the
various systems of the body and stated with great accuracy the required dosage
from juice, bark or decoctions as well as the toxic dose. Finally, they
outlined the action of antidotes, adjuvants and alternative remedies.
The Muslims
must be given the credit for developing the science of botany
(12,13,21). Ibn El Bitar is
one of the greatest Arabian botanists (2,20,22,23).
His book Al Gami Al Kabir
is the most original among the Arabic materia medica
texts of the mediaeval period. Arabic materia
medica had a considerable impact on European
herbal and antidotarium authors from the 12th to the
17th century (2,4,24,25).
Conclusion
The only
conclusion possible is that the writings of the Muslim scholars in their Latin
form influenced European medical thought over a very considerable period.
References
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