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Anesthesia 1000 years ago

Al-Mazroa and Abdel-Halim shared an article and an essay on the history of anesthesia, which was published in Saudi Medial Journal and in the proceeding on the international history of anesthesia held in London 1986. In which they stated that Pain is a subjective experience, which requires the presence of consciousness. Over the ages there has been a demand for methods of relief. The purpose of their paper is to report on the use of narcotics for pain relief from antiquity up to the Renaissance.

Greek and Roman medicine

Celcus in the 1st century used opium and mandrake for pain relief, Galen in the 2nd century recommended great care with the use of powerful narcotics such as opium, considering it a dangerous drug. In cases of colic or other violent pains he used only opium. He was considered as reference to what the medical knowledge in his time is mounted to, summarizing the Greek medicine.

By the time of Paulus in the 7th century opium fallen to disuse.

The Middle Ages

In the Middle Ages Christian Europe was in state of intellectual stagnation. The theological doctrine that pain served Godís purpose and not to be alleviated.

However the rising Islamic civilization in the East between 9th and 16th century helped in reviving the study of various sciences including Medicine. It is not surprising to see that Ibn Sina (Avicenna), Al-Razi (Razes), Al- Bagdady and Ibn Al-Koff. Paid a great attention to the phenomenon of pain. They attributed pain to the breach of continuity (as stated by Galen as the only cause) but also to change of the temperament with or without abnormal humours. Hence they stressed the treatment of the underlying causes and they subsequently developed a large number of analgesics with variable modes of action. The anesthetics they described included a wide range of medical plants as well as ice and ice cold water.

They attributed the anesthetic action of the various medical plants used to a specific poisonous property of variable strengths. According to Avicenna opium is the most powerful, then mandrake, papaveris, henbane or hyocyamus, hemlock, solanum and wild lettuce. These agents especially opium were used as local anesthetics in dental cases, earaches, 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 filling.

Gargles made from decoctions of mandrake root, henbane root or the seed and root of solanum were used also.

For earache all the following items were used: opium drops in rose oil, infusion of solanum root, papaveris decoction, henbane oil or juice.

For eye pain relief they either used dressing made of mandrake leaves or they mixed other eye medicine with mandrake or hemlock juice

For joints pains they used mandrake leaves dressing or opium, hemlock, henbane and cannabis embrocations.

They noticed that severe pain may lead to death so the soporific action of the available drugs was used especially for surgical operation like amputation, cautery, circumcision and lacerations treatment. The method of employment varied from ingestion, inhalation or rectal administration. Infusions of solanum, cannabis, opium, mandrake and henbane were also given orally or rectally on a plug, which was changed frequently. Inhalation of these agents as odorants was described.

The wild lettuce was considered a mild soporific and it was given either fresh or boiled in combination of the previously mentioned drugs or alone for insomnia.

These physicians were able to describe the specific actions and side effects of the drugs. Also they were aware of the length of action expected which denote personal experience and observation. They had a system of fine measurements to the prescribed drugs using variable weights pound, dirham, dinarium etc..)

Arabic materia medica was full of descriptions of the characters of the agents used method of collection and the method of preparation.

 

Reference: Al-Mazroa A.A. and Abdel-Halim R.E.: Anesthesia 1000 years ago. Royal society of Medicine International congress and Symposium Series No. 134: 46-47,1989

Summarized by: M.S.M. Takrouri. Department of Anesthesiology, KSU. Riyadh 11461 KSA P.O.Box 2925