History

The history of anaesthesia from ancient times to the present day can be divided into four distinctive periods: herbs, vapours, local anaesthetics, and ''modern-day'' medications (opioids, hypnotics, relaxants, etc.).

Herbs

Mankind gradually discovered pain relieving, hypnotic properties of plants existing in nature. This dates back to 5500 B.C., as underlined by an archaeological find in a cave site southern Spain. Here found in a religious artefact, were intact capsules of opium poppy (papaver somniferum).¹

In 3000 B.C. (the Early Bronze Age) in the Swiss Lake dwellings caches of poppy seeds and press-cake were found. Although to date there is no evidence that it was used as a narcotic in either of the above time periods, it is plausible that in the Early Bronze Age, opium poppy was grown in Switzerland, enabling the large numbers of seeds that could be harvested to press for oil and to be ground for flour (dough).²

In ancient China (1500 B.C.), India and pre-Columbian America, natural anaesthetics or soporifics were used to ease some types of pain, including that associated with surgical procedures. Among the first known records mentioning the anaesthetic properties of cannabis are from China dating to the third century.³

Although they did not generally consider it as a means of pain-relief, there is evidence that cannabis was also available to Egyptians, and Arabs and ancient Scythians (700-200 B.C.).³

Hippocrates, (c. 460 B.C.-c. 370 B.C.), ancient Greek physician, ''father of medicine'', acknowledges opium's usefulness as a narcotic.¹

The Romans also took their share in the early days of anaesthesia. In his work Naturalis Historia (77 A.D.), Gaius Plinius Secundus (23-79 A.D.), also known as Pliny the Elder, warned of the dangers of opium. However, during its use as a medicine, these warnings did not prevent people from becoming addicted to it. He also refers to the effect of the odour of mandragora as causing sleep, and mentioned it as the ''potion of the condemned,'' used to reduce pain for prisoners who were crucified.^{2, 3}

   

Pedanius Dioscorides (~40-~90 A.D.) a Greek physician, pharmacologist, who practiced in Rome under the rule of Nero, was a surgeon of the roman army. This facilitated a unique opportunity in his quest to collect medical substances from both the Greek and Roman civilizations.

In his famous five volume book De Materia Medica he describes mixtures being prepared from opium and other plants (e.g., mandragora) as surgical anaesthetics. He was the first person to use the word ''anaesthesia,'' in the sense of an absence of sensation. ^4,5

   

Claudius Galenus of Pergamum (129-~200 A.D.) another ancient Greek physician, worked at a gladiator school for three or four years. During this period he gained wide experience in the management of trauma and wounds. He advised the use of mandragora and alcohol before surgery, which could relieve pain to some extent.⁴

Avicenna of Persia (980-1037 A.D.) a Persian physician, taught in 1020 that opium is ''the most powerful of stupefacient's.'' Ferdowsi (935-1020 A.D.), one of the greatest Persian poets, also illustrates the general knowledge of anaesthesia in ancient Persia, in his poetic opus, Shahnameh (The Epic of Kings). In this he writes about a Caesarean section performed on a female, for which she was made unconscious by a special alcoholic beverage prepared by a Zoroastrian priest.⁴

Vapours

Although it was not to be used for surgical procedures until the mid 19th century, the synthesis of ether from sulfuric acid and alcohol by Valerius Cordus (1515 - 1544), a German botanist and pharmacist (apothecary) was a great leap for anaesthesia. He called his compound oleum dulci vitrioli or ''sweet oil of vitriol''. He described it in his pharmacopeia Dispensatorium which he presented to Nurnberg city council in 1542, and was published as Dispensatorium Noricum in 1546. Despite the fact, that he considered it to be medically useful, no evidence is available to confirm that he would have recognized its anaesthetic properties.^4,6

Paracelsus (1493-1546) a Swiss physician and a contemporary of Valerius Cordus experimented independently from the German with ether, and he was the first one to realize the hypnotic effects of ether. ''Of all the things extracted from vitriol it is most remarkable because it is stable. And besides, it has associated with it such a sweetness that it is taken even by chickens, and they fall asleep from it for a while but awaken later without harm...''⁷

The substance was named ''ether'' by a German born London chemist Joannes Sigismundus Augustus Frobenius, a member of the Royal Society.⁸ In 1730, he described the properties of spiritus vini aethereus during a meeting of the Royal Society.⁹

References:

1. Bitter-Sweet Harvest: Afghanistan's New War: UN Office for the Coordination of Humanitarian Affairs, 2004.
2. Gibson AC. Plants and Civilization., 1999.
3. O'Brien ME. Overpowering pain: A serious problem comes out of the closet. Postgraduate Medicine 1997; 102:198-271.
4. Wikipedia.
5. Pearce D. Utopian Surgery: Early arguments against anaesthesia in surgery, dentistry and childbirth. 2004.
6. Evans TJ. The Unusual History of Ether, 1998.
7. Lehrer S. Explorers of the body: Dramatic breakthroughs in medicine from ancient times to modern science.: Doubleday, 1979:75.
8. Fellows of the Royal Society: The Royal Society.
9. Tilton H. Of Ether And Colloidal Gold: The Making of a Philosophers' Stone.