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2012-10

Primer on Medical History for Anesthesiologists: Introduction

Manisha S. Desai University of Massachusetts Medical School

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Repository Citation Desai MS, Desai SP. (2012). Primer on Medical History for Anesthesiologists: Introduction. Anesthesiology and Perioperative Medicine Publications. Retrieved from https://escholarship.umassmed.edu/anesthesiology_pubs/155

This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Anesthesiology and Perioperative Medicine Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. 22 bulletIN OF ANESTHESIA HISTORY Primer on Medical History for Anesthesiologists: Introduction By Manisha S. Desai, MD Department of Anesthesiology University of Massachusetts Worcester, Masschusetts and Sukumar P Desai, MD Department of Anesthesiology, Perioperative and Pain Medicine Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts

Editor’s note: The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a survey of medical history. The goals of this primer are 1) to educate, and 2) to help individuals target future study. Below is the first article in a continuing series.

As few anesthesia historians and enthu- BCE] established a community rooted in as prognosis. Although Hippocratic physi- siasts have undergone formal training in philosophy and mathematics, and he is cians believed that body would heal itself, history, the primary purpose of this series is known for contributions in geometry, ir- they also believed that they could assist in to provide a historic perspective about major rational numbers, immortality of the soul, this process by balancing the four important events that form the basis of modern science, and reincarnation. Plato [circa 428-348 body fluids–blood [energy], yellow bile medicine, and anesthesia. We hope these BCE], a student of Socrates [circa 469-399 [anger], black bile [depression], and phlegm broad horizons help readers better appreci- BCE], was one of the first to use scientific [slow temperament]. They also treated frac- ate the human and societal context in which inquiry by formulating general principles tures and drained abscesses and hematomas. advances in these disciplines occurred. through observing individual objects. In Hippocrates is best remembered for his strict History of Science: The word ‘science’ the dialogue Timaeus, Plato describes the moral code of the Hippocratic Oath. is derived from the Latin scientia which origin and structure of the world and its History of Anesthesia: Man has sought means ‘knowledge.’ In the past, the term contents. In addition to articulating the relief from the cardinal symptom of pain natural philosophy was used for the study characteristics of a harmonious society, the since times immemorial. Introduction of of the natural world. From historical re- Timaeus also posits the rationale underlying nitrous oxide and ether in the middle of the cords, it is apparent that ancient Western human anatomy and physiology. Pythagoras 19th century greatly accelerated the develop- science began with the Babylonians who and Plato believed that the world was created ment of surgery, but prior to the mid-1840s, lived in the first and second millennia BCE by design, rather than by random events. painful procedures were still necessary, and in present day Iraq and with the Egyptians. Plato’s student Aristotle [384-322 BCE] the role of anesthetic agent was served by The Babylonians left their writings on clay still influences ideas about ethics, logic, substances known to be analgesics, sedatives, tablets, and their main contributions were and biology. amnesiacs, or hallucinogens. Agents most in astronomy and mathematical notation History of Medicine: Paleomedical often quoted in the literature are alcohol, [using a base of 60, a practice currently evidence from between 2,000-10,000 BCE opium, cannabinoids, and the belladonna followed in the measurement of time in supports the existence of diseases such as derivatives. seconds and minutes]. The Egyptians used tuberculosis, arthritis, and bony abnormali- Alcohol: Winemaking traces its origins a solar calendar of 360 days and 5 days of ties and treatments such as trephination of to those of agriculture, civilization, and festivals. They introduced metalworking the skull, perhaps to remove blood or to let society. The fermentation process has been and glassmaking. Thales of Miletus [circa out evil spirits. Imhotep [circa 2900 BCE] applied as early as 9000 BCE in Georgia 600 BCE] in Greece is credited with start- in Egypt, and Hippocrates [460-370 BCE] and 5000 BCE in regions surrounding the ing the scientific tradition of searching for in Greece, are individuals clearly identified Mesopotamian basin. Its use was known causes and principles to explain observations with the practice of medicine. Prior to Hip- in ancient Greece and Egypt. Grape juice made in nature. Thales and other pre- pocrates, Aesculapian practices included was used in most of these regions, but in Socratics concerned themselves with ques- prayers and rituals, since disease and illness the Middle East honey and dates were tions related to what the world was made were believed to occur from supernatural substituted. The use of alcohol fumes as an of, how the universe was created, where the causes. Hippocrates, the father of Western anesthetic was recorded in the mid-16th cen- world came from, how changes occur, and medicine, is credited with ascribing natural tury. Surgeons would occasionally intoxicate whether the senses were accurate guides for causes to illness, carrying out careful ob- patients with alcohol in the 18th and 19th investigation. Other significant individuals servation and examination of patients, and century, especially when the ‘procedure ne- include Anaximander, Anaximenes, Heracli- keeping accurate records of the progress cessitated freedom from struggling.’ In 1842, tus, Parmenides, Empedocles, Leucippus, of illness. These practices allowed Hippo- a painless dental extraction was reported and Democritus. Pythagoras [circa 570-495 cratic physicians to offer diagnosis as well under alcohol anesthesia. Although alcohol BULLETIN OF ANESTHESIA HISTORY 23 was administered intravenously in as early and hyoscamine. Other names used for anesthesia. as 1668, there was no mention of its use as plants or extracts that contain these and Next: We shall discuss other advances an analgesic. With the availability of modern other similar compounds include henbane, made in science during the classical period, agents, intravenous alcohol anesthesia has mandrake, and mandragora. Preparations the role of Galen and how his work influ- been used rarely during the past century. that contain belladonna derivatives provided enced medical thinking for almost a mil- Opium: The poppy Papaver somniferum relief during surgery by delirium, hallucina- lennium, and the period of the 1840s during (Figure 1) has been cultivated at least since tions, and amnesia. These drugs have also which our specialty was born. the Neolithic Age [10,000 BCE]. Inhabitants long been used as poisons, and the term bel- in the Middle East, India, Egypt, as well as ladonna (“beautiful lady”) is derived from Additional Reading those in the Greek and Roman empires were Italian, as Venetian ladies used these herbs 1. Lindberg DC. The Beginnings of Western Sci- ence, 2nd Edition. Chicago: University of Chicago aware of the analgesic effects of opium. The to dilate their pupils and appear attractive. Press; 2007. term opium refers to the dried milky extract Soporific Sponges: These were used as 2. Singer C, Underwood EA. A Short History of vehicles for delivering vapors during sur- Medicine, 2nd Edition. Oxford: Oxford University Press; 1962. gery. Sea sponges were soaked in a variety 3. Chadwick J, Mann WN. The Medical Works of of potions containing alcohol, opium, bel- Hippocrates. Oxford: Blackwell Scientific Publica- ladonna alkaloids, and even poisons such tions; 1950. 4. Keys TE. The History of Surgical Anesthesia. as hemlock [which contains many toxins Park Ridge, Illinois: Wood Library-Museum of including the neurotoxin coniine]. After Anesthesiology; 1996. absorbing these potions, the sponge was dried out. The sponge would be moistened with warm water and placed near the nose before and during the surgical procedure. Mesmerism: Franz Mesmer introduced Mesmerism in Vienna in 1775. He had a fanatical following in Europe, and the tech- Fig. 1. Papaver somniferum. Wood Library- nique was used to cure a variety of illnesses Museum of Anesthesiology, Park Ridge, IL. and to relieve pain during surgery. It was not Reproduced with permission. always effective as an anesthetic, although of the fruit of this plant. It contains several it was used widely in Europe as well as the alkaloids [naturally occurring compounds colonies in Asia. It was largely abandoned with basic nitrogen groups], mainly mor- after a French committee that included phine [12% by weight], as well as smaller Benjamin Franklin amongst its members amounts of codeine, papaverine [a smooth determined that the technique was a fraud. muscle relaxant and vasodilator], thebaine Other Methods: Bleeding, nerve com- [a stimulant chemically related to morphine pression, bilateral carotid artery compres- that can also be used to manufacture other sion, and exposure of the skin to be incised narcotics such as oxycodone, oxymorphone, to various chemicals were other techniques nalbuphine, naloxone, naltrexone, and used to obtain relief from surgical pain. buprenorphine], and noscapine [a non- Summary: Man’s ingenuity in obtaining analgesic cough suppressant]. Dried opium pain relief allowed many patients to be ren- was used by itself or, more commonly, as a dered unaware during surgical procedures. mixture with other plant ingredients to offer It is likely that many patients succumbed to relief for a wide variety of disorders. overdose of these potent agents and toxins. Cannabinoids: The active ingredient However, it is also possible that combining tetrahydrocannabinol [THC] is just one of drugs with different mechanisms of action several dozen cannabinoid compounds that allowed practitioners a margin of safety not can be harvested from several plant species possible with the use of only one drug. This [Cannabis sativa, Cannabis indica, among might represent the earliest use of balanced others] and these plant derivatives have been called hemp, hashish, ganja, marijuana, etc. THC stimulates cannabinoid receptors in the central nervous system. TCH provides mild to moderate analgesia, suppresses nausea, increases appetite, reduces fatigue, alters visual and auditory sensations, and promotes a sense of relaxation. As with opium, the preparation could be used alone or combined with other ingredients. Belladonna Derivatives: These ingre- dients are obtained from the deadly night- shade plant Atropa belladonna (Figure 2). Fig. 2. Atropa belladonna. Wood Library- The active ingredients in the plant extract Museum of Anesthesiology, Park Ridge, IL. include atropine, hyoscine [scopolamine], Reproduced with permission.