ANÆSTHESIA.
The use of the vapor of sulphuric ether for the purpose of inducing insensibility to surgical operations was first practically adopted by Dr. Morton, of Boston, in 1846; that of chloroform, by Dr. Simpson, of Edinburgh, in 1847. To this period we must assign the most important epoch in the annals of surgery, and the date of one of the grandest discoveries of science and one of the greatest blessings ever conferred upon humanity.
The idea, however, of saving the human body, by artificial means, from the pains and tortures inflicted by the knife of the surgeon, has been by no means either first broached or first acted upon in recent times. Intense pain is regarded by mankind generally as so serious an evil that it would have been strange indeed if efforts had not been early made to diminish this species of suffering. The use of the juice of the poppy, henbane, mandragora, and other narcotic preparations, to effect this object by their deadening influence, may be traced back till it disappears in the darkness of a remote antiquity.
Intoxicating vapors were also employed, by way of inhalation, to produce the same effects as drugs of this nature introduced into the stomach. This appears from the account given by Herodotus of the practice of the Scythians, several centuries before Christ, of using the vapor of hemp-seed as a means of drunkenness. The known means of stupefaction were very early resorted to in order to counteract pain produced by artificial causes. In executions under the horrible form of crucifixion, soporific mixtures were administered to alleviate the pangs of the victim. The draught of vinegar and gall, or myrrh, offered to the Saviour in his agony, was the ordinary tribute of human sympathy extorted from the bystander by the spectacle of intolerable anguish.
That some lethean anodyne might be found to assuage the torment of surgical operations as they were anciently performed, [cauterizing the cut surfaces, instead of tying the arteries,] was not only a favorite notion, but it had been in some degree, however imperfect, reduced to practice. Pliny the Naturalist, who perished in the eruption of Vesuvius which entombed the city of Herculaneum in the year 79, bears distinct and decided testimony to this fact.
In his description of the plant known as the mandragora or circeius, he says, “It has a soporific power on the faculties of those who drink it. The ordinary potion is half a cup. It is drunk against serpents, and before cuttings and puncturings, lest they should be felt.” (Bibitur et contra serpentes, et ante sectiones, punctionesque, ne sentiantur.)
When he comes to speak of the plant eruca, called by us the rocket, he informs us that its seeds, when drunk, infused in wine, by criminals about to undergo the lash, produce a certain callousness or induration of feeling (duaitiam, quandam contra sensum induere).
Pliny also asserts that the stone Memphitis, powdered and applied in a liniment with vinegar, will stupefy parts to be cut or cauterized, “for it so paralyzes the part that it feels no pain” (nec sentit cruciatum).
Dioscorides, a Greek physician of Cilicia, in Asia, who was born about the time of Pliny’s death, and who wrote an extensive work on the materia medica, observes, in his chapter on mandragora,—
1. “Some boil down the roots in wine to a third part, and preserve the juice thus procured, and give one cyathus of it in sleeplessness and severe pains, of whatever part; also to cause the insensibility—to produce the anæsthesia ποιειν αναισθησιαν—of those who are to be cut or cauterized.”
2. “There is prepared, also, besides the decoction, a wine from the bark of the root, three minæ being thrown into a cask of sweet wine, and of this three cyathi are given to those who are to be cut or cauterized, as aforesaid; for, being thrown into a deep sleep, they do not perceive pain.”
3. Speaking of another variety of mandragora, called morion, he observes, “Medical men use it also for those who are to be cut or cauterized.”
Dioscorides also describes the stone Memphitis, mentioned by Pliny, and says that when it is powdered and applied to parts to be cut or cauterized, they are rendered, without the slightest danger, wholly insensible to pain. Matthiolus, the commentator on Dioscorides, confirms his statement of the virtues of mandragora, which is repeated by Dodoneus. “Wine in which the roots of mandragora have been steeped,” says this latter writer, “brings on sleep, and appeases all pains, so that it is given to those who are to be cut, sawed, or burned in any parts of their body, that they may not perceive pain.”
The expressions used by Apuleius of Madaura, who flourished about a century after Pliny, are still more remarkable than those already quoted from the older authors. He says, when treating of mandragora, “If any one is to have a member mutilated, burned, or sawed, [mutilandum, comburendum, vel serrandum,] let him drink half an ounce with wine, and let him sleep till the member is cut away without any pain or sensation [et tantum dormiet, quosque abscindatur membrum aliquo sine dolore et sensu].”
It was not in Europe and in Western Asia alone that these early efforts to discover some lethean were made, and attended with partial success. On the opposite side of the continent, the Chinese—who have anticipated the Europeans in so many important inventions, as in gunpowder, the mariner’s compass, printing, lithography, paper money, and the use of coal—seem to have been quite as far in advance of the Occidental world in medical science. They understood, ages before they were introduced into Christendom, the use of substances containing iodine for the cure of the goitre, and employed spurred rye (ergot) to shorten dangerously-prolonged labor in difficult accouchements. Among the therapeutic methods confirmed by the experience of thousands of years, the records of which they have preserved with religious veneration, the employment of an anæsthetic agent to paralyze the nervous sensibility before performing surgical operations, is distinctly set forth. Among a considerable number of Chinese works on the pharmacopœia, medicine, and surgery, in the National Library at Paris, is one entitled Kou-kin-i-tong, or general collection of ancient and modern medicine, in fifty volumes quarto. Several hundred biographical notices of the most distinguished physicians in China are prefixed to this work. The following curious passages occur in the sketches of the biography of Hoa-tho, who flourished under the dynasty of Wei, between the years 220 and 230 of our era. “When he determined that it was necessary to employ acupuncture, he employed it in two or three places; and so with the moxa if that was indicated by the nature of the affection to be treated. But if the disease resided in parts upon which the needle, moxa, or liquid medicaments could not operate,—for example in the bones, or the marrow of the bones, in the stomach or the intestines,—he gave the patient a preparation of hemp, (in the Chinese language mayo,) and after a few moments he became as insensible as if he had been drunk or dead. Then, as the case required, he performed operations, incisions, or amputations, and removed the cause of the malady; then he brought together and secured the tissues, and applied liniments. After a certain number of days, the patient recovered, without having experienced the slightest pain during the operation.”
Almost a thousand years after the date of the unmistakable phrases quoted from Apuleius, according to the testimony of William of Tyre, and other chroniclers of the wars for the rescue of the holy sepulchre, and the fascinating narrative of Marco Polo, a state of anæsthesia was induced for very different purposes. It became an instrument in the hands of bold and crafty impostors to perpetuate and extend the most terrible fanaticism that the world has ever seen.
The employment of anæsthetic agents in surgical operations was not forgotten or abandoned during the period when they were pressed into the appalling service just described. In the thirteenth century, anæsthesia was produced by inhalation of an anodyne vapor, in a mode oddly forestalling the practices of the present day, which is described as follows in the surgical treatise of Theodoric, who died in 1298. It is the receipt for the “spongia somnifera,” as it is called in the rubric:—
“The preparation of a scent for performing surgical operations, according to Master Hugo. It is made thus:—Take of opium and the juice of unripe mulberry, of hyoscyamus, of the juice of the hemlock, of the juice of the leaves of the mandragora, of the juice of the woody ivy, of the juice of the forest mulberry, of the seeds of lettuce, of the seed of the burdock, which has large and round apples, and of the water-hemlock, each one ounce; mix the whole of these together in a brazen vessel, and then place a new sponge in it, and let the whole boil, and as long as the sun on the dog-days, till it (the sponge) consumes it all, and let it be boiled away in it. As often as there is need of it, place this same sponge in warm water for one hour, and let it be applied to the nostrils till he who is to be operated on (qui incidentus est) has fallen asleep; and in this state let the operation be performed (et sic fiat chirurgia). When this is finished, in order to rouse him, place another, dipped in vinegar, frequently to his nose, or let the juice of the roots of fenigreek be squirted into his nostrils. Presently he awakens.”
Subsequent to Theodoric’s time, we find many interesting and suggestive observations in the writings of Baptista Porta, Chamappe, Meissner, Dauriol, Haller, and Blandin. About half a century ago, Sir Humphry Davy thus hinted at the possibility that a pain subduing gas might be inhaled:—“As nitrous oxide, in its extensive operation, appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.” Baron Larrey, Napoleon’s surgeon, after the battle of Eylau, found a remarkable insensibility in the wounded who suffered amputations, owing to the intense cold. This fact afterwards led to the application of ice as a local anæsthetic.
The former general belief that a degree of anæsthetic and prolonged sleep could be induced artificially by certain medicated potions and preparations is also shown by the frequency with which the idea is alluded to by the older poets and storytellers, and made part of the machinery in the popular romance and drama. In the history of Taliesin, (one of the antique Welsh tales contained in the Mabinogion,) Rhun is described as having put the maid of the wife of Elphin into a deep sleep with a powder put into her drink, and as having cut off one of her fingers when she was in this case of artificial anæsthesia. Shakspeare, besides alluding more than once to the soporific property of mandragora, describes with graphic power in Romeo and Juliet, and in Cymbeline, the imagined effects of subtle distilled potions supposed capable of inducing, without danger, a prolonged state of death-like sleep or lethargy. And Thomas Middleton, in his tragedy of Women beware Women, published in 1657, pointedly and directly alludes in the following lines, to the practice of anæsthesia in ancient surgery:—
Hippolito. Yes, my lord,
I make no doubt, as I shall take the course,
Which she shall never know till it be acted;
And when she wakes to honor, then she’ll thank me for’t.
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;
So out of love to her I pity most,
She shall not feel him going till he’s lost;
Then she’ll commend the cure.—Act iv. Sc. 1.
The following curious lines from Du Bartas, translated by Joshua Sylvester (?) are also well worth transcribing in this connection.
Du Bartas died about the year 1590:—
Even as a Surgeon minding off-to-cut
Som cureless limb; before in use he put
His violent Engins on the vicious member,
Bringeth his Patient in a senseless slumber:
And griefless then (guided by Use and Art)
To save the whole saws off th’ infested part.
So God empal’d our Grandsire’s (Adam) lively look,
Through all his bones a deadly chilness strook,
Siel’d-up his sparkling eyes with Iron bands,
Led down his feet (almost) to Lethe’s sands;
In briefe, so numm’d his Soule’s and Bodie’s sense,
That (without pain) opening his side, from thence
He took a rib, which rarely He refin’d,
And thereof made the Mother of Mankind.
The history of anæsthetics is a remarkable illustration of the acknowledged fact that science has sometimes, for a long season, altogether lost sight of great practical thoughts, from being unprovided with proper means and instruments for carrying out those thoughts into practical execution; and hence it ever and anon occurs that a supposed modern discovery is only the rediscovery of a principle already sufficiently known to other ages, or to remote nations.