Anæsthetics in the Middle Ages

An early Irish anæsthetic

In a Celtic manuscript of the twelfth century on materia medica, a preparation called “potu oblivionis” is mentioned, of which mandragora was probably an ingredient. A draught of this preparation was used by the early Irish to induce sleep.

The “Sleeping Sponge”

Coming to the fifteenth century, the method of producing insensibility to pain by the inhalation of the volatile principles of drugs, which had been handed down by tradition from the early ages, seems to have been revived by Hugo of Lucca, a Tuscan physician. He is described as “chief of a school of surgeons that treated wounds with wine, oakum and bandaging, with happy success.” Theodoric, his son, who was a monk-physician, and practised surgery, mentions, in 1490, a preparation used by his father which he calls “oleum de lateribus.” This he describes as “a most powerful caustic, and a soporific which, by means of smelling alone, could put patients to sleep on occasion of painful operations which they were to suffer.” The mixture was Method of using the “Sleeping Sponge”placed on a sponge in hot water, and then applied to the nostrils of the patient, and was called the “spongia somnifera.” The following is the composition of the “sleeping sponge” and the method of using, as stated by Theodoric: “Take of opium, of the juice of the unripe mulberry, of hyoscyamus, of the juice of hemlock, of the juice of the leaves of mandragora, of the juice of the woody ivy, of the juice of the forest mulberry, of the seeds of lettuce, of the seeds of dock, which has large round apples, and of the water-hemlock, each an ounce: mix all these in a brazen vessel, and then place in it a new sponge; let the whole boil as long as the sun lasts on the dog-days, until the sponge consumes it all, and has boiled away in it. . . . As oft as there shall be need of it, place this sponge in hot water for an hour, and let it be applied to the nostrils of him who is to be operated on until he has fallen asleep, and so let the surgery be performed.”

An Operation on the Liver

From an MS. of the XIV century

According to Bodin, the sleep produced was so profound that the patient often continued in that condition for several days afterwards. The method of arousing the patient employed by Hugo, however, is thus described: “In order to awaken him, apply another sponge, dipped in vinegar, frequently to the nose, or throw the juice of fenugreek into the nostrils; shortly he awakens.”

According to Canappe, in his work “Le Gyidon pour les Barbiers et les Chirurgiens,” published in 1538, the “Confectio soporis secundum dominum Hugonem” was used by surgeons at that period.

A Surgeon Amputating a Leg

From a woodcut of the XVI century

Reginald Scott, in a work written in the sixteenth century, gives the following recipe for making an anæsthetic: “Take of opium, mandragora bark and henbane root, equal parts; pound them together, and mix with water. When you want to sew or cut a man, dip a rag in this, and put it to his forehead and nostrils. He will soon sleep so deeply that you may do what you will. To wake him up, dip the rag in strong vinegar. The same is excellent in brain-fever, when the patient cannot sleep; for if he cannot sleep, he will die.”

Anæsthesia in romance

The writers and poets of mediæval romance in more than one instance allude to anæsthesia produced by drugs. Boccaccio, who wrote his “Decameron” in 1352, in the story of Dionius, alludes to a certain anæsthetic liquid of Surgeon Mazzeo della Montagna, of Salerno. “The doctor,” he says, “supposing that the patient would never be able to endure the pain without a soporific, deferred the operation until the evening, and in the meantime ordered the water to be distilled from a certain composition, which, being drunk, would throw a person asleep as long as he judged it necessary.” Boccaccio, probably, borrowed his idea from the recipe given by Nichols, a provost of the famous old school of Salerno, who published a recipe for making an anæsthetic, similar to that of Reginald Scott.

In Brooke’s “Tragicall Historye of Romeus and Julietta,” printed in 1562, which supplied Shakespeare with the plot and much material for his play “Romeo and Juliet,” Friar Laurence thus speaks to Julietta: “I have learned and proved of long time the composition of a certain paste which I make of divers somniferous simples, which beated afterwards to powdere, and dronke with a quantitie of water, within a quarter of an houre after, bringeth the receiver into such a sleepe, and burieth so deeply the senses and other spirits of life that the cunningest phistian will judge the party died.

“And, besides that, it hath a more marvellous effect, for the person which useth the same feeleth no kind of grief, and, according to the quantitie of the draught, the patient remaineth in a sweete sleepe; but when the operation is perfect and done, he returneth unto his first estate.”

A Surgeon Amputating a Leg

From a woodcut of the XVI century

Shakespeare’s references to mandragora, poppy and other “drowsy syrups,” are too well known to need quotation; but the following allusion by Middleton, in his play called “Women beware Women!” is not without interest:—

I’ll imitate the pities of old surgeons

To this lost limb, who, ere they show their art,

Cast one asleep, then cut the diseased part.

William Bulleyn, the author of “A Bulwark of Defence against Sickness,” who practised as a surgeon in the reign of Henry VIII, describes an anæsthetic which he directs to be prepared from the juice of a certain herb (probably mandragora) “pressed forth, and kept in a closed earthen vessel according to art, bringeth deep sleep, and casteth man into a trance, or deep terrible sleep, until he shall be cut of the stone.”

Allusions to anæsthesia by antient poets

The poet Marlowe thus refers to mandragora in his play “The Jew of Malta”:—

Barabas:

I drank of poppy and cold mandrake juice,

And being asleep, belike they thought me dead,

And threw me o’er the walls.

Du Bartas, as translated by Sylvester in 1592, makes the following allusion to anæsthesia:—

Even as a surgeon minding off to cut

Som cureless limb; before in use he put

His violent engins in the victim’s member,

Bringeth his patient in a senseless slumber:

And griefless then (guided by use and art)

To save the whole, saws off the infested part.

Porta, writing in 1579, says: “It is possible to extract from several soporific plants a quintessence, which is to be shut up in a well-covered leaden vessel, lest the drug should evaporate. When it is to be used, the lid is to be removed and the medicament held to the nostrils, when its vapour will be drawn in by the breath and attack the citadel of the senses, so that the patient will be sunk in a deeper sleep not to be shook off without much labour.”

A Surgeon Performing an Operation on the Eye

From a woodcut of the XVII century

Besides mandragora, opium, Indian hemp, and other plants with narcotic properties already referred to, that were used for anæsthetic purposes in mediæval times, certain substances are mentioned by early writers that cannot be identified. Thus Albertus Magnus mentions an animal product, of which he says: “Any person smelling it falls down as if dead and insensible to pain,” but there is no reference to such a drug by other writers of the period.

Local anæsthetics in antient times

Local anæsthesia was not unknown during the middle ages, and Cardow recommends the inunction of a mixture consisting of “opium, celandine, saffron, and the marrow and fat of man, together with oil of lizards.” He also adds: “If the patient drinks wine in which the seeds of the patulica marina have been steeped for a week, it will prevent him feeling any pain.”

First men­tion of freez­ing as an anæs­the­tic

Bernard mentions that it was customary in Salerno to mix the crushed seeds of poppy and henbane, and apply them as a plaster, to deaden sensibility, to parts that were about to be cauterised; while Bartolinus states that local anæsthesia was sometimes produced by freezing, thereby foreshadowing the use of ether and ethyl chloride as local anæsthetics.

During the seventeenth century the belief in the narcotic draughts of the antients for producing anæsthesia appears to have waned, and few allusions are made to them until the middle of the eighteenth century, when fresh interest seems to have been excited in the subject. The famous Boerhaave is said to have used opium as an anæsthetic, both by inhalation of its vapour and also by internal administration in powder.Boerhaave’s anæsthetic According to Van Swieten, in his commentaries upon Boerhaave’s “Aphorisms,” the following is given as the recipe: “Oil of cinnamon, 2 drops; oil of cloves, 1 drop; citron peel, 2 grains; sugar, 2 drachms. Mix and add red coral, prepared, 1 drachm; pure opium, 2 grains. Mix for two doses, one of which is to be taken one hour before the operation, and the other one quarter hour before it, if the patient has not slept.”

An Operation in the Seventeenth Century

From a painting by Franz Hals

An operation on the King of Poland

In 1782, Weiss is said to have operated on the foot of Augustus, King of Poland, having previously placed the royal patient under the influence of “a certain potion surreptitiously administered.” Shortly afterwards Sassard, a surgeon of La Charité, in Paris, suggested that patients who were about to be operated upon should be drugged with narcotics as a means of preventing shock. That this method was sometimes practised is evidenced from a chapter in “Bell’s Surgery,” where the author not only refers to it but objects to the method on account of the sickness and vomiting it produced.

As late as 1847, Chisholm, of Inverness, recorded his use of a drug given internally to produce anæsthesia for surgical purposes; he substituted the internal use of morphine for ether inhalation in a case of ablation of the breast successfully performed upon a woman, who declared that she felt no pain during the operation.

Anæsthesia by com­pres­sion of the carotid arteries revived

Other means of producing insensibility were suggested in the eighteenth century, and the antient method of compressing the carotid arteries was revived. This method had been used by Valverdi about 1560, and Morgagni employed it about 1750 in his experiments on animals, and suggested that it might be used on human beings. Compression of the nerves of the limb about to be removed, was also proposed, by James Moore in 1784, and tried by Hunter and others, but the results could not be regarded as successful.

Nelson’s arm amputated

Surgical operations at this time meant periods of agonising pain, and the stoutest hearts often quailed at the prospect. It is said that Lord Nelson was so painfully affected by the coldness of the operator’s knife when his right arm was amputated at Teneriffe, that at the Battle of the Nile he gave orders to his surgeon to have hot water kept ready, so that at the worst he might be operated upon with a warm knife.

The dawn of a new era

Thus from the dawn of creation anæsthesia for surgical operations had been practised to some extent, but, owing to the uncertainty of the potency and action of the powerful narcotics and palliatives administered, and the danger attending their use when exact science was unknown, the practice seemed likely to fall into oblivion. At last a series of brilliant discoveries in chemistry created a new epoch in the history of anæsthesia.