Anaesthesia 1000 Years Ago

 

ADNAN A. AL-MAZROOA and RABIE E. ABDEL-HALIM

University Hospital, Jeddah, Saudi Arabia

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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

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The Parthenon Publishing Group

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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 2ndCentury (as stated by Cumston (2) and De Moulin (3)) recommended greatcare with the use ofpowerful 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 Europe were dark ages so far as advances in the pharmacology of anaesthesia was concerned. However in the East, with the firm establishment of the Muslim supremacy between the 9th and 16th Century, the study of medicine along with other branches of science revivedand acquired atruly scientific nature (2,4,13,14),

Therefore, not only Avicenna (16) but also Al-Razi (17), Al Baghdady (I8) and Ibn El Kuff (19), paidgreat 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 ofanalgesics 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 thebeginning. Refrigeration anaesthesia which is considered by some to be a modern discovery, thus,had itsorigin in the medicine ofthe 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 mandrakeroot, 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 ofhenbane 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 ofthese 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 thevarious 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, adjuvantsandalternative remedies.

The Muslimsmust 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 materiamedica 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). Constantine wrote nothing original; all his books are plagiarisms or skilfully disguised translations from the Arabic. The medicinal remedies reported by Dioscorides are thus of Islamic origin (2). The same may be said of the work of Celsus which was hardly noticed by the Greeks and overlooked in the Middle Ages (26). In the section on emollients (Vol. II), Celsus describes one of them as the invention of a certain Arab. and some of his recipes are based on Arabicmateria medica with its tables of weights and measures (pound, dirham and dinarium or dinarii).

 

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

 

(I) Celsus. De Medicina. London: Heinemann; Cambridge: Harvard University Press, 1938, Vols 1-3.

(2} Cumston C G. An introduction to the history of medicine from the time of the Pharoahs to the end of the XVIII Century. London: Dawsons. 1968.

(3) De Moulin D. A historical phenomenological study of bodily pain in Western man. Bull Hist Med 1974; 48: 540-70.

(4) Campbell DC. Arabian medicine and its influence on the Middle Ages, 1st Ed. (reprint). Amsterdam: Philo Press, 1974.

(5) Paulus Aegineta. The seven books of Paulus Aegineta, translated by F. Adams. London, Sydenham Society, 1844-1847, Vols 1-3.

(6) Keys T. The history of surgical anaesthesia. New York: Schumannís, 1945.

(7) Nuland SB. The origins of anaesthesia. Birmingham: The Classics of Medicine Library, 1983.

(8) Tallmadge GK. Some anaesthetics of antiquity. J Hist Med All Sci 1946: 1: 515-20.

(9) Horine FE. Episodes in the history of anaesthesia. J Hist Med All Sci 1946; 1: 521-6.

(10) Kitz RJ, Vandam LD. A history and the scope of anaesthetic practice. In: Miller RD ed. Anaesthesia Vol 1, 2nd ed., New York: Churchill Livingstone, 1986, 3-25.

(II) Bickers W. Adventures in Arabian Medicine. J Roy Coll Surg Ir 1969; 5: 5-14.

(12) Desnos E. The history of urology up to the latter half of the thirteenth century. In: Murphy LJT, ed. The history of urology. Springfield: Thomas, 1972.

(13) Dickinson EH. The medicine of the ancients.Liverpool: Holden, 1875.

(14) Kirkup JR. The history and evolution of surgical instruments. I. Introduction. Ann Coll Surg Engl 1981; 63: 279-85.

(15) Sigrid Hunke. Allah's sonne uber dem abendland unser Arabische erbe, Arabic Translation by F. Baidoon and K. Dosoky, 6th Ed. Beirut: Dar AI-Aafak AI-Jadida, 1981.

(16) Ibn-Sina. Kitab AI-Qanu fi T-tibb. (The Canon of Medicine). Beirut: Dar Sadir, reprint of Cairo Boulak edition, 1877.

(17) Al-Razi. Kitabul Hawi fi T-Tibb (Rhazes Liber Continens), Vol 23, 1st Ed., Hyderabad: Osmania Oriental Publications, Osmania University, 1961,

(18) AI-Bagdady. Kitab AI-Mukhtarat Fil Tibb, Vols 1-4, 1st Ed. Hyderabad: Osmania Oriental Publications, Osmania University, 1942-1944.

(19) Ibn El Kuff. AI-Omda Fil Jiraha, Vol 1-2, 1st Ed. Hyderabad: Osmania Oriental

Publications, Osmania University, 1936.

(20) Ibn El Bitar. Jami Mufradat Al-Adwia Wa AI-Aghzia (A Dictionary of simple drugs) manuscript No. 3979, Chester Beatty Library Dublin-Microfilm at Imam

Ibn Saud University Library Riyadh-1399.

(21) Margotta R. In: Lewis, P, ed. An illustrated history of medicine. Feltham: Hamlyn, 1968.

(22) Hamerna SK. Tareekh AI-Tibb Wa Assaidala Endal Arab, Vol 1-2, Cairo: 1967.

(23) Ibn Abi-Usaybia. Uyunal-Anba Fi Tabaqat AI Atibba (The sources of the knowledge of classes of doctors). Beirut: Dar Maktabat al-Hayat, 1965.

(24) Garrison FH. An introduction to the history of medicine, 3rd Ed. Philadelphia and London: Saunders, 1924.

(25) Dunlop DM. Arabic medicine in England. J Hist Med 1956; 2: 166-82.

(26) Guthrie D. A history of medicine. London: Thomas Nelson, 1945.