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
London New
York
And
The
Parthenon Publishing Group
International
Publishers In Science & Technology
Caslerton
Hall, Camforth, 120 Mill
Road. Park Ridge
Lancs, LA6 2LA, U.K.
New Jersey, U.S.A.
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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 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
revived and acquired a truly scientific nature (2,4,13,14),
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).
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 Arabic materia 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.
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