Opium and ether: the development of anesthesia
In ancient Greek, anaisthìsía literally meant anesthesia, namely to bring about a condition in which a person is deaf, i.e. does not feel any pain in a certain part of his body. But it could also mean to become mentally deaf, to fall into stupidity. This condition was explicitly triggered by a human being on another human being, on purpose.
Various means of relieving pain from the sick have been handed down since antiquity and worldwide. The cultures in the Andean region used this for a long time. The leaves of the coca bush, however, we do not know whether the extensive skull operations in Inca medicine were also carried out under Coca anesthesia.
Quacks and charlatans
Until well into the Middle Ages, alcohol was used in Europe to make suffering more bearable, but opium also served this purpose in various ways; people ate it, mixed it with wine, or smoked it. From time to time the quacks moving from fair to fair earned a golden nose with this “Theriak”.
She betrayed the sick by giving them their "miracle medicine", which did not remove the cause of the suffering, but temporarily relieved the pain and brought them into a state of happiness. If this died away and the pain returned, the charlatan was long over all mountains.
Folk medicine knew various “magical plants” to forget worries and numb hunger and pain. However, the better the effect, the greater the risk: cardiac arrest, psychoses, shock conditions and "horror trips" could hardly be avoided, and the "best" means of sweet dreams quickly led to eternal sleep.
Deadly cherries and henbane, hemlock and thorn apple were just some of the remedies from the folk pharmacy that paralyzed and produced hallucinations. One thesis even says that the German purity law had the purpose of removing the "bilsen" from the beer, because, similar to absinthe today, people intensified the effect of alcohol in wine and beer with henbane and even more dangerous substances.
Until modern times, doctors used natural substances to relieve pain: opium, alcohol, cannabis or cocaine. Hypnosis has been known since ancient times, and medical doctors around the world have also used techniques that do not require any chemical means: cold, pressure or bloodletting. Acupuncture also proved successful, not because of supposed "acupuncture points" in the body, but because the pain in the pierced area redirected the great pain.
In the beginning there was a fish
Anesthesia is also derived from Greek, nárkì referred to the electric ray that emits electrical charges. Narkáo meant to stun and described the act with which the trembling rays paralyzed living beings.
The Greeks knew about electricity, and they knew about the electric shocks of electric fish. The ancient Egyptians also previously knew the electric current of the trembling catfish that lives in the Nile. The Greek adopted the word nár as a tribe of nárki from the Egyptians.
The Egyptians probably had their own experiences when they touched the quaking catfish (Malapterus electricus). The predatory fish is about sixty centimeters long and can emit up to 30 electric shocks with a strength of up to 100 volts. These are not enough to paralyze people. Local anesthetic pain would be possible if the fish was taken directly out of the water and placed directly on the appropriate part of the body.
The electric ray lives in the Mediterranean, and its power surges reach up to 200 volts. The Greeks presumably used it to numb the sick locally before operations, but this is not proven.
Acupuncture as anesthesia?
Chinese medicine used acupuncture 4000 years ago, in a time of demon belief. In acupuncture, doctors irritate the main pathways in the body with needles to control the imaginary life force Chi. What is essential for this is the metal of the needles, namely gold or silver, and the direction in which they are turned. In ancient times, the purpose of stabbing with a needle was to drive the demon out of the body.
In modern times, acupuncture served as a substitute for anesthesia. That probably has nothing to do with the Chinese tradition.
Sleeping sponge and hemlock
The early Christians forbade to numb pain because God wanted those affected to suffer. However, in practice, doctors in the early and high Middle Ages used various techniques to numb pain.
For example, they pressed the blood vessels in the neck until the patient lost consciousness or cut off nerves. The widespread bloodletting could also be used for anesthesia if the affected persons became unconscious due to the blood loss.
In 880 a sleep sponge has survived from Bamberg, and a code from Monte Cassino has survived from the same period, from which such a sponge was made. The doctor dipped a (natural) sponge into a brew of opium, hyoscyamine, mulberry juice, lettuce (?), Hemlock, mandragora and ivy. Then he let the sponge dry, moistened it again and the patient inhaled the resulting vapors.
In 1200 the Duke of Lucca reported about his sleeping drink made of opium, hemlock. Henbane and mandrake. He soaked a sponge and used it to perform small operations. So that those affected woke up again, he held a sponge with wine vinegar under their noses.
Mallet and opium
The doctors usually tied the patients to a chair, or strong men fixed them with physical strength. They often used the "mallet method". They padded the skulls of the patients with wool or a helmet, then slapped the victim on the back of the head until they lost consciousness. This form of anesthesia often led to concussion with long-term consequences.
Arabian doctors pulled the carotid artery or gave the patient opium. These methods only seeped into the Western medicine in fragments, although the Crusaders brought them to Europe.
In the Middle Ages, operations on the human body meant pain for the patient that we can hardly imagine. The surgeons who worked the fastest to cut the inevitable pain had the best reputation. Doctors only operated in extreme emergencies.
The sweet sleep
Nightshade plants have been known as narcotics since ancient times. The mandrake (mandragora) was even considered a magic plant. Like deadly cherries and thorn apple, the mandrake root is highly toxic, and the art has always been in the dosage.
In the Middle Ages, wine with mandrake extracts was used for anesthesia. Patients drank the mixture "before cutting and burning, pricking and puncturing a limb to erase the sensation and feeling in such unusual practices."
Drug lover Paracelsus
Paracelsus (1493-1541), a doctor and alchemist at the same time, discovered the narcotic effects of the ether, which he called a sweet vitriol, shortly before his death. He observed that chickens picked the vitriol, fell asleep and woke up without damage.
Paracelsus is considered the founder of modern medicine and brought to the point what healers probably knew from experience since the Stone Age: "dose facit venenium", "the dose makes the poison".
He explained: "If you want to explain each poison correctly, what is not a poison? All things are poison and nothing is without poison, only the dose means that a thing is not poison. "
If Paracelsus had known that opiates, unlike alcohol, were banned in western countries, he would have been surprised. Because he called opium "laudanum", the commendable.
The English chemist Joseph Priestley discovered nitrogen oxide in 1772, better known as laughing gas. It euphorizes consumers and, as the name suggests, makes them laugh uncontrollably.
Its importance for medicine remained hidden for decades; the laughing gas initially spread as a party drug. Variety artists and carnival barkers use it to amuse the audience.
Boston dentist Horace Wells attended a show by entertainer Gardner Quincy Colton in 1844 and realized that the audience, intoxicated by the nitrous oxide, felt no pain. His knowledge was correct, but his first attempt to use the gas for anesthesia failed. In 1845 he wanted to present his discovery to the scientific public and gave a patient laughing gas. But the victim screamed, the doctors present thought Wells was a spinner, and the dentist committed suicide shortly afterwards.
Although ether had been known since Paracelsus, it was not until 1845 that a doctor underwent a surgical operation under ether anesthesia. Robert Liston (1798-1847) amputated a leg to an anesthetized patient in just 28 seconds. Amputations previously meant cruel pain, and many patients died from the shock caused by the pain.
Dentist William Morton learned his trade from the unfortunate Horace Wells. Two years after Well's public embarrassment, he had a patient inhale sulfur ether from a glass flask and then successfully removed a tumor in the left lower jaw.
Thereby ether was established as a narcotic and alongside chloroform became the most important anesthetic of modern times.
It interrupts the process in which the brain passes on the pain information and also inhibits the reflexes of the muscles, so it helps twice in operations. The remedy works similarly to alcohol, but much faster and more effectively.
In the 19th century ether was also popular as a drug because the blockage of the cerebral cortex dampened self-criticism and led to euphoria. This temporary exhilaration can lead to psychological dependence. But ether addiction no longer plays a role in Germany.
The anesthetic is not harmless. Similar to alcohol, anesthesia is followed by a “hangover” associated with nausea and vomiting. Drinking ether can cause gastritis. This is one of the reasons why doctors today use other narcotics that cause fewer side effects.
Justus Liebig discovered chloroform in 1831. The gynecologist James Young Simpson personally tested it in 1847 and used it shortly afterwards while helping the child of a pregnant woman into the world. The baby christened the mother "Anesthesia". The American doctor Oliver Wendell Holmes (1809-1894) then called the method anesthesia, and the term has been used ever since.
Chloroform finally came to a breakthrough when Queen Victoria of England took it in 1853 when her son Leopold was born. Your doctor, John Snow, became the first full-time anesthetist.
Chloroform and ether were by no means safe. Especially old and weak patients played Russian roulette if they were operated on under these anesthetic. In severe operations, up to 90% of all patients died from anesthetics.
The first anesthetist: God
Christian fundamentalists considered anesthesia at birth to be blasphemy and relied on being driven out of paradise. There God says to Eve: “I want to create a lot of pain for you when you become pregnant; you should give birth to children with pain. "
However, clever doctors also referred to the Bible. Because it contains the first traditional anesthetic of humanity through God personally. Genesis II, 21 reports on the creation of Eve: "And then the Lord dropped a deep sleep on man (Adam) so that he fell asleep, took one of his ribs and sealed the flesh over it."
If you take the Bible not literally but as a historical source, you can see in this quote that the ancient chroniclers of the Middle East knew the anesthetic process, namely to consciously "put someone to sleep" in order to perform an operation on the body.
The risks were enormous and many patients did not need general anesthesia. Doctors have long known local anesthetics for minor surgeries, such as ice cubes.
Cocaine offered a perspective. Siegmund Freud took it and his friend Carl Koller, an ophthalmologist from Vienna, successfully used it to numb a patient's cornea. A New York neurologist, James Leonard Cocain, experimented with cocaine on the spinal cord of dogs and invented spinal anesthesia. The surgeon Karl August Bier (1861-1846) finally injected cocaine solutions into the spinal canal and thus shaped lumbar anesthesia.
In 1904, the first open chest operation was performed without the patient stopping breathing. Franz Kuhn discovered positive pressure ventilation.
In 1932, Helmut Weese used Evipan. This "sleep injection" made the patient forget the fear of anesthesia. From 1950 onwards, doctors finally began using various new anesthetics that could be dosed better, had a more targeted effect, and the duration of their effects could be calculated: 1952 morphine, 1956 halothane, 1960 fentanyl, 1966 enflurane, later sufentanil and alfentanil.
Since the 1960s, many German hospitals have had their own anesthesia departments that work closely with intensive care medicine. Anesthesiologists are inseparable from emergency medicine, and surgeons can now perform operations that would have been impossible a hundred years ago thanks to anesthesia.
Today's anesthetics are very safe; Every operation is risky, but even patients with severe, life-threatening physical ailments have a risk of only 5.5 per 10,000 anesthesia. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
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