Wednesday, 14 January 2015

Ancient Anaesthetics

Have you ever noticed how every time you go into hospital for surgery the doctor always points out that one of the possible outcomes is death? They always point it out and then get you to sign the forms so they have proof that you were indeed aware that there was a chance that you might go to sleep and never wake up.
This is not a modern phenomenon.
There are limited examples of drug use in antiquity to enable surgery, but the clearest example was provided by the first century AD herbalist, Dioscorides:
     "... some say that [this kind of mandrake] puts one to sleep when as little as a drachma is consumed in a drink, or when eaten in a barley-cake, or when eaten in [any] prepared food.  The individual falls asleep in whatever position he might have been in, when he ate it, and then feels nothing for three or four hours from the time it was given to him. Physicians about to perform surgery or apply cautery use this also."
          De Materia Medica, IV.75.7, trans. John Scarborough, "Mandrake in Ancient Surgery," p. 4 (find it on Academia.org).
Theophrastus, the third century BC philosopher, mentions that mandrake is good for sleeplessness (Inquiry into Plants, 9.9.1), but Pliny the Elder ( first century AD) provides more details of its dangerous nature:
     "The mere smell brings heaviness of the head and ... those who in ignorance smell too much are struck dumb, while too copious a draught even brings death. When the mandrake is used in a sleeping draught the quantity administered should be proportioned to the strength of the patient, a moderate dose being a cyathus. It is also taken in drink for snake bite, and before surgical operations and punctures to produce anaesthesia. For this purpose some find it enough to put themselves to sleep by the smell.
          Pliny, Natural History, 25.94.150.
While Pliny and Dioscorides discuss the use of anaesthetics in relation to surgery, the Roman doctor Celsus (who similarly lived in the first century AD) does not mention any use of anaesthetics in his book on surgery (Book 7 of De Medicina). This us not to say Celsus didn't use drugs in his practice of medicine. Celsus not only refers to compounds which treat pain, but which also acted as soporifics, for example:
     "Pills are also numerous, and are made for various purposes. Those which relieve pain through sleep are called anodynes; unless there is overwhelming necessity, it is improper to use them; for they are composed of medicaments which are very active and alien to the stomach. There is one, however, which actually promotes digestion; it is composed of poppy-tears [opium] and galbanum, 4 grams each, myrrh, castory, and pepper, 8 grams each... Another, worse for the stomach, but more soporific, consists of mandrake 1 gram, celery-seed and hyoscyamus seed, 16 grams each, which are rubbed up after soaking in wine."
          Celsus, De Medicina, 5.25.
Poppy and opium [referred to as poppy-juice or poppy-tears] were common ingredients in Celsus, yet Theophrastus does not mention once the soporific effect of the opium poppy in his small discussions of it (1.12.2 and 9.15.1). Dioscorides goes into more details about poppies, including a discussion of the generation of opium (De Materia Medica, 4.65), as does Pliny (Natural History 20.76.198-9). 
Dioscorides and Pliny appear to use some of the same sources. Dioscorides (4.64) wrote:
     "Erasistratus says that Diogoras disallows the use of it [poppy] for those who are sick with ear sores or eye sores, because it is a duller of the sight and a causer of sleep."
Pliny states (20.76.200):
     "Diogoras and Erasistratus have utterly condemned it as a fatal drug, forbidding its use moreover, in injections on the ground that it is injurious to eyesight."
As for the deadly nature of poppies, Pliny (20.76.199) says:
     "...it is not only a soporific, but if too large a dose be swallowed, the sleep ends even in death."
He even goes on to mention how opium was used by the father of a praetorian man to euthanise himself. By comparison, Dioscorides (4.65) writes that too much poppy too often "hurts (making men lethargic) and it kills."
While I am sure that I won't be fed mandrake tomorrow, an anaesthetist has told me he would prefer to give me an epidural rather than a general anaesthetic. I would prefer to hear the mandrake's scream* and die, rather than hear my own bones sawn in preparation for a total knee replacement. That said, I hope that the form I signed saying "Yes, I am recognisant of the fact that I could die" is unnecessary.



*I had thought that the belief that mandrake's scream folklore originated in antiquity, but have discovered that it was actually medieval.  If you would like to know more about its development because you are a Harry Potter fan, check out this link: https://online.uni-graz.at/kfu_online/wbFPCompsCallBacks.cbExecuteDownload?pDocStoreNr=142771

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