From Out of the Primordial Soup:

A Brief History of Anaesthesia by Robert Hirst MB ChB
Department of Anaesthesia Sheffield Teaching Hospitals

Anaesthesia has been around in one form or another since around the 12th century and in some sense hundreds to thousands of years B.C. In the last 150 years however a revolution of anaesthesia has occurred with exponential growth in knowledge and substances available for use in anaesthesia making it one of the most advanced specialities in modern medicine. The following essay considers the core roots of our speciality and looks briefly ahead to see what the future may hold.

Primitive Anaesthesia

Medieval anaesthesia was primitive and barbaric when compared to the standards employed today. The most common before the 15th century was probably the use of liberal quantities of alcohol plus or minus opium and a wooden stick to bite down upon. However some of the substances used in this period still hold strong today suchas opium and some are even being ‘rediscovered’ such as Cannabis in chronic pain.Arabic alchemist were perhaps some of the most advanced in their beliefs on anaesthesia in the 12th and 13th centuries employing techniques such as the soporific sponge which was a sponge steeped in hashish, opium and other herbal aromatics.  When required for surgery it would be moistened and held over the face inducing a state of unconsciousness. Writings about this practice can be found in Sir Richard Burton’s translation of The Arabian nights (1).

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(2)  Formal reference to the use of an anaesthetic agent for surgical intervention occurs around 1540 when dioscorides refers in his pharmacopoeia to:  ‘Sleeping potions made from opium and mandragora root which may be used as surgical anaesthetics for such people whom be cut or cauteried’ (3)  Mandragora continued to be a popular choice of anaesthetic upto the middle ages and was a mythical and respected plant. It was felt that the mandrake plant whose roots resembled a human form would kill the person who picked it if the screams of the root were heard. For this reason the plant was uprooted in novel ways such as tying the loosened plant to the collar of a dog and allowing the dog to uproot the plant, a practice that would be frowned upon by the RSPCA no doubt.

(4)  Mandrake was usually combined with a blend of opium and hemlock and either rendered the patient unconscious or dead, as hemlock shows zero order kinetics and is a toxic piperidine alkaloid.

3  One of the commonest anaesthetic potions used was the ‘Dwale Potion’ from the medieval word dwale meaning confused or dazed. This comprised the gall from a castrated boar, lettuce, hemlock, henbane opium, mandrake and bryony.

(5)  When the walls of the opium poppy are incised a latex like substance is secreted, from which many of the useful products are derived including opium and the isoquinoline alkaloid derivates morphine, codeine, noscapine, papaverine and thebaine.  The Sumerians were the first to cultivate the poppy as far back as 3200 B.C. There is a feeling among some medical historians that the poppy itself is integrated into human culture and that this is one of the reasons that eradication of the illegal opium trade is so difficult. The first writings of opium overdose appear around 1037 A.D when the Islamic physician Avicenna died of an accidental overdose. A famous quote, which still holds true today, was in the 17th century when Thomas Syndenham wrote:

‘ There is no other pain killer that is so universal and efficacious as morphine’ (6)  As you can see from the above techniques the balance between life and death was even more tenuous during anaesthesia than it is today. So when did things start to change?  Certainly the longest standing substance used in anaesthesia throughout history and into modern day are extracts from the opium poppy, papaver somniferum meaning the poppy of sleep.

4  Evolution

From these primitive beginnings little changed in anaesthesia until the end of the 18th century. During this time a rapid evolution occurred in the practice of anaesthesia largely due to certain key individuals who shaped the foundations of our speciality as it stands today.  The discovery of ‘dephlogisated nitrous air’ or nitrous oxide as we now know it, by Joseph Priestly was the catalyst for this evolution. The discovery occurred at the end of the 18th century but the relevance of the discovery was not stumbled across until a couple of years later in the early 19th century when a chemist, Humphrey Davy, conducted some ‘physiological’ experiments with the gas.

(8)  Davy was a remarkable if somewhat erratic chemist who was not only responsible for the above discovery but many others such as the Davy miners’ lamp and many of the properties of the Alkali Earth metals. He died May 29th, 1829 at the age of 51 from a myocardial Infarction following a prolonged illness considered to be brought on by the inhalation of many gases over his lifetime.  Despite Davy’s work it wasn’t until 45 years later in 1844 when nitrous oxide was  used as an anaesthetic by Gardner Colton and Horace Wells. Colton was a travellingAt the age of 21, Davy a keen chemist was employed as a superintendent of the medical pneumatic institution of Bristol to investigate the properties of various gases and their application to medicine. A quote in the diary of an observer at the time states, ‘He breathed 16 quarts of the gas over a period of 7 minutes and became completely Humphrey Davy intoxicated.’ (7)

to be continued tomorrow!