Anesthesia - history, methods and risks

Opium and ether: the development of anesthesia

Anaesthìsía in ancient Greek meant literally anesthetic, namely to bring about a state in which a person is deaf, that is, who feels no pain at a certain point of his body. But it could also mean to become mentally deaf, that is, to succumb to stupidity. One person expressly triggered this condition on another person, on purpose.

Various remedies for alleviating pain have been handed down since ancient times and worldwide. The cultures in the Andes area used this long v. However, we do not know whether in Inca medicine the extensive cranial operations were also performed under coca-anesthesia.

contents

• Opium and ether: the development of anesthesia
• Quacks and charlatans
• magic plants
• In the beginning there was a fish
• Acupuncture as anesthesia?
• Sleep sponge and hemlock vapor
• Mallet and opium
• The sweet sleep
• Drug addict Paracelsus
• laughing gas
• ether
• chloroform
• The first anesthetist: God
• Local anesthesia
• Modern anesthesia

Quacks and charlatans

In Europe, alcohol was used to make suffering more bearable well into the Middle Ages, but opium also served this purpose in various ways; people ate it, mixed it with wine or smoked it. The quacks, who went from fair to fair, sometimes earned a golden nose with this "Theriak".

In earlier times, people used opium, among other things, to relieve pain. (Image: Miroslav Beneda / fotolia.com)

It deceived the sick by giving them their "miracle medicine" that did not eliminate the cause of their suffering, but quickly relieved those affected of the pain and put them into a state of happiness. When this sounded, and the pain returned, the charlatan had long since crossed the mountains.

magic plants

Folk medicine knew various "magical plants" to forget the worries and to numb hunger and pain. However, the better the effect, the greater the risk: cardiac arrest, psychosis, shock and "horror trips" were hard to avoid, and the "best" means of sweet dreams quickly led to eternal sleep.

Belladonna and henbane, hemlock and thorn apple were just some of the resources of the People's Pharmacy, which caused severe paralyzes and hallucinations. One thesis even states that the purpose of the German Purity Law was to remove the "Bilsen" from the beer, because, as is still the case today with absinthe, 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 had been known since antiquity, as well as doctors all over the world used techniques that did not require chemical agents: cold, pressure or bloodletting. Also acupuncture proved to be successful, not because of supposed "acupuncture points" in the body, but because the pain in the pierced place redirected the great pain.

Acupuncture was used to "redirect" the actual pain. (Image: Africa Studio / fotolia.com)

In the beginning there was a fish

Anesthesia is also derived from the Greek, nárkì called the electric jitter, which discharges electric charges. Narkáo meant to numb and denote the act by which the electric rays paralyzed creatures.

The Greeks knew electricity, and they knew about the electric shocks of electric fish. The ancient Egyptians also knew the electric current of the shivering catfish that lives in the Nile. The word nár as tribe of nárki took over the Greeks from the Egyptians.

Probably the Egyptians made their own experiences when they touched the shivering catfish (Malapterus electricus). The predatory fish is about sixty centimeters long and can deliver up to 30 electric shocks in a strength up to 100 volts. For a paralysis of people, these are not enough. It would be possible to anesthetize pain locally if the fish is taken directly out of the water and placed directly on the appropriate body part.

The echinoderm lives in the Mediterranean, and its surges reach up to 200 volts. The Greeks probably used it to stun patients locally before surgery, but it is not proven.

Acupuncture as anesthesia?

Chinese medicine used acupuncture 4000 years ago, in a time of demonic belief. In acupuncture, the doctors stimulate accepted major tracts in the body with needles to control the imaginary life force Chi. Essential for this is the metal of the needles, namely gold or silver, and the direction in which they are turned. In ancient times, needle piercing had the purpose of driving the demon out of the body.

In modern times, acupuncture served as an anesthetic replacement. That probably has nothing to do with the Chinese tradition.

Sleep sponge and hemlock vapor

The early Christians forbade pain to numb because God wanted the sufferer to suffer. However, in practice, early and early middle-aged physicians used various techniques to numb pain.

For example, they squeezed the blood vessels of the neck until patients lost consciousness or nerves. The widespread bloodletting could also be used for anesthesia, if those affected by the blood loss were unconscious.

In the early and high Middle Ages, for example, the highly poisonous hemlock was used for stunning. (Image: Oleksandrum / fotolia.com)

In 880, a sleeping sponge was handed down from Bamberg, and a codex from the Monte Cassino from the same period handed down, which consisted of such a sponge. The doctor dipped a (natural) sponge in a broth 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 fumes.

In 1200, the Duke of Lucca reported his sleeping potion of opium, hemlock. Henbane and mandrake. He soaked a sponge and used it to perform small operations. To wake them up again, he held a sponge with wine vinegar under their noses.

Mallet and opium

The doctors usually tied the patients in a chair, or strong men fixed them with physical strength. Often enough, they also used the mallet method. They padded the patient's skull with wool or a helmet, then beat the victim on the back of the head until it lost consciousness. This form of anesthesia often led to a concussion with long-term consequences.

Arab doctors cut off the carotid artery or gave the patient opium. In western medicine, these methods seeped in crumbs, although the crusaders brought to Europe.

Operations on the human body in the Middle Ages meant pain for patients that we can hardly imagine. The best reputation had the surgeons who worked the fastest to shorten the unavoidable pain. Doctors operated only in extreme emergency.

The sweet sleep

Nightshades have been known as narcotics since ancient times. The mandrake (Mandragora) was even considered a magical plant. Like belladonna and datura, the roots of the mandrakes are highly toxic, and the art has always been in the dosage.

In the Middle Ages wine served with mandarin extracts for anesthesia. Patients drank the mixture "before cutting and burning, stinging and puncturing a limb to erase the sensation and sensation of such extraordinary practices."

Paracelsus is considered the founder of modern medicine. He coined the phrase: "The dose alone makes the poison". (Image: tauav / fotolia.com)

Drug addict Paracelsus

Paracelsus (1493-1541), physician and alchemist at the same time, discovered shortly before his death the narcotic effect of the ether, which he described as sweet vitriol. He watched chickens pick up the vitriol, fall asleep and wake up again without harm.

Paracelsus is considered the founder of modern medicine and summed up what probably healers knew from the Stone Age from experience: "dose facit venenium", "the dose makes the poison".

He explained, "If you want to explain every poison properly, what is not poison? All things are poison and nothing is without poison, only the dose causes a thing is not a poison. "

Had Paracelsus known that opiates, unlike alcohol, are outlawed in western countries, he would probably have wondered. For opium he called "Laudanum", the praiseworthy.

laughing gas

The English chemist Joseph Priestley discovered in 1772 the nitric oxide, better known as nitrous oxide. It euphoricizes consumers and, as the name implies, makes them laugh uncontrollably.

Its importance for medicine remained hidden for decades; the nitrous oxide spread for the time being as a party drug. Variety artists and carnival screamers used it to amuse the audience.

The Boston dentist Horace Wells visited in 1844 a show by the entertainer Gardner Quincy Colton and realized that the laughing gas intoxicated audience felt no pain. His finding was true, 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 nitrous oxide. But the person complained that the doctors present thought Wells was a nutcase, and the dentist took his life shortly thereafter.

ether

Although ether was known since Paracelsus, but only in 1845, a doctor undertook a surgical operation under ethereal anesthesia. Robert Liston (1798-1847) amputated one leg in just 28 seconds for such an anesthetized patient. Amputations previously meant cruel pain, and many patients died from the shock of the pain.

The 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 his left lower jaw.

Thus, ether was established as a narcotic and was next chloroform the most important narcotic of modernity.

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 much like alcohol, but much faster and more effective.

In the 19th century, ether was also popular as a drug, because the blockage of the cerebral cortex inhibits self-criticism and leads to euphoria. This passing elation can lead to mental dependence. Aetherism no longer plays a role in Germany today.

The narcotic is not dangerous. The narcosis is followed by a "hangover", similar to alcohol, associated with nausea and vomiting. Drinking ether can cause gastritis. That's why doctors today use other narcotics that cause fewer side effects.

Justus Liebig discovered chloroform in the mid-19th century. The narcotic gained a high reputation after being given to Queen Victoria of England in 1853 during a birth. (Image: Zerbor / fotolia.com)

chloroform

Justus Liebig discovered in 1831 the chloroform. The gynecologist James Young Simpson tested it in 1847 on his own body and put it shortly thereafter, while he helped the child of a pregnant woman in the world. The baby christened the mother "anesthesia". The American physician Oliver Wendell Holmes (1809-1894) then described the method with anesthesia, and since then the term has held.

The breakthrough came Chloroform final when Queen Victoria of England took it in 1853 at the birth of her son Leopold. Her doctor, John Snow, became the first full-time anesthetist.

Chloroform and ether were by no means harmless. Particularly old and weak patients played Russian roulette when they were operated on under narcosis. In severe operations, up to 90% of all patients died of narcotics.

The first anesthetist: God

Christian fundamentalists considered anesthesia at birth to be blasphemy and invoked the expulsion from paradise. There, God says to Eve, "I want to cause you much pain when you get pregnant; you should bear children with pain. "

However, wise doctors also referred to the Bible. Because it contains the first traditional narcosis of humanity by God personally. Genesis II, 21, tells of the creation of Eve, "And the Lord God caused a deep sleep to fall on man (Adam), so that he fell asleep, took one of his ribs and closed the flesh over it."

Those who do not take the Bible literally, but as a historical source, recognize in this quote that the ancient chroniclers of the Middle East knew the process of anesthesia, namely, deliberately "putting one's sleep to sleep" in order to perform an operation on the body.

Local anesthesia

The risks were enormous and many patients did not need general anesthesia. The doctors have long known local anesthesia for minor procedures such as ice cubes.

One perspective offered cocaine. 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 the lumbar anesthesia.

Through the development of anesthesia today operations can be performed that would have been unimaginable a hundred years ago. (Image: Herjua / fotolia.com)

Modern anesthesia

In 1904, the first operation was performed on the open chest, without the patient ceasing to breathe. Franz Kuhn discovered positive pressure ventilation.

In 1932 Helmut Weese used Evipan. This "sleep injection" made patients forget the fear of anesthesia. From 1950, physicians used various new anesthetics, which can be dosed better, more targeted and their duration of action can be calculated: 1952 morphine, 1956 Halothan, 1960 fentanyl, 1966 enflurane, later sufentanil, alfentanil and atracurium.

Since the 1960s, many German hospitals have their own anesthesia departments, which work closely with intensive care medicine. Anaesthesiologists are an inseparable part of emergency medicine, and thanks to anesthesia today, surgeons are able to perform operations that would have been impossible a hundred years ago.

Today's anesthetics are very safe; every surgery carries risks, but even patients with severe, life-threatening physical ailments only have a risk of 5.5 per 10,000 anesthesia. (Dr. Utz Anhalt)

Literature:
Kretz, Schäffer: Anesthesia Emergency Medicine Pain Therapy, Springer 2008
Striebel: anesthesia, intensive care medicine, emergency medicine for study and training, Schattauer 2013