Researchpaper Anesthesia Drugs in the Medieval Muslim Era

8/13/2019 Researchpaper Anesthesia Drugs in the Medieval Muslim Era

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International Journal of Scientific & Engineering Research Volume 4, Issue3, March-2013 1ISSN 2229-5518

IJSER 2013http://www.ijser.org

Anesthesia Drugs in the Medieval Muslim Era

Dr. Ali Muhammad Bhat

Dept. of Islamic Studies IUST Awantipora Pulwama Srinagar Jammu and Kashmir 192122

Abstract

Pain is difficult to measure in humans because it has an emotional or psychological as wellas a physical component. Some people express extreme discomfort from relatively smallinjuries, while others show little or no pain even after suffering severe injury. The signalsthat warn the body tissue damage are transmitted through the nervous system. In thissystem, the basic unit is the nerve cell or neuron. Each nerve cell meets other nerve cells at

certain points on the axons and dendrites, forming a dense network of interconnected nerve fibers that transmit sensory information about touch, pressure, or warmth, as well as pain.Sensory information is transmitted from the different parts of the body to the brain viaspinal cord. To overcome pain different types of drugs were used from the very earlier

period to restrict the nerve signals for some time in order to provide relief to the patient. At present highly modified drugs are prescribed to ease pain whether at the time of surgery or feeling any kind of pain in the body. In order to highlight the significance of medievalmedicine prescribed to ease pain and save human beings from side effects, this topic hasgreat significance in the contemporary era.

Keywords: Pain, Anesthesia, Analgesic Surgery, Tabiaa (Physician), Lettuces, Mandrake (Hashish),

(El-Khishkash), Shweikran , Bhang and hyoscyamus .

Science and medicine belong to no ethnic or national group. Of the countless scientific discoveries

made by man, medical discovery are the outline of the many partial contributions made by

forerunners throughout the ages. These discoveries are related to universal facts. Countless human

sufferings whether psychological or physical needs Medicare in order to provide relief to human

beings. Pain is a one-sided occurrence which necessitates the presence of consciousness. It is the

sensation which is experienced by Consciousness. From the ages people are in search of pain

relieving drugs. Over the ages there has been a demand for techniques in order to endow with relief

from different kinds of pains. This whole process has been entitled as anesthesia and analgesics.

Anesthesia means absence of physical sensation in part or all of the body. The term more commonly

refers to a reversible condition that is stimulated using anesthetic drugs. These drugs may be

injected, gulp, or applied directly to the surface of the body. Each year about 40 million patients in


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the United States receive anesthetic drugs for surgery, obstetrics, dentistry, or other medical

procedures. Induced anesthesia may be local, involving only part of the body, or general, involving

lack of sensation in the entire body as well as a loss of consciousness. 1 Localized anesthesia can also

be a result of natural causes, such as nerve injury, leprosy, or diabetes. An analgesic, or pain-

relieving drug such as aspirin, may relieve a headache, but a person who takes an aspirin still feels

other physical sensations, such as pressure, heat, cold, and vibration. In contrast, anesthetic drugs

block all physical sensations, though for medical purposes their ability to block pain is among their

most important effects. Pain is a crucial warning system that tells us when our bodies are in danger,

but without anesthesia, pain would make surgery and various other medical procedures much more

difficultor even impossible. The various drugs used in anesthesia work by several different

mechanisms to block the transmission or perception of pain and other sensations. Some sleep-

producing drugs used as part of general anesthesia are injected into a patients veins. 2 These drugs

are taken up by organs, muscles, and brain tissue and interfere with the complex and poorly

understood biochemical mechanisms of consciousness. Anesthetic drugs that are inhaled dissolve in

the blood and circulate to the brain. These drugs interfere with the chemicals inside nerve fibers that

are involved in transmission of nerve impulses .

Over the ages scholars like Celsus, Galen and Paulus proved us information about the drugs used as

anesthetic drugs in order to relieve a patient from the pain. After Galen; Greek medicine produced

four writers who did not contribute any advancement. Their works mainly consisted of quotations

from Hippocrates and Galen 3 .

As a consequence, the strong narcotic drug mandrake used by Celsus 4 seems to have fallen into

neglect; confirmation of this is that Paulus 5 in the 7th Century, who is regarded as having summed

up all medical knowledge accumulated up to his time, did not use it in his trochaics as an anodyne.

Paulus did not give the toxic dose or details of the specific actions of either mandrake or opium. It

1 Myers L B, Cohen D, Galinkin J, Kurth D. Anesthesia for the fetal surgery. Peadiatric Anaesthesia 2002, Vol, P 269-5782 Stanley F. Malamed, Hand Book of Local Anesthesia, Elsevier - Health Sciences Division, 2012, p: 10-203 Campbell DC, Arabian medicine and its influence on the Middle Ages . Amsterdam: Philo Press, 1974, (reprint).4 Celsus, De Medicina . London: Heinemann; Cambridge: Harvard University Press, 1938, vols 1-3.5 Paulus Aegineta, The seven books of Paulus Aegineta , translated by F. Adams. London, Sydenham Society, 1844-1847, vols 1-3.


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seems that there was no standardization or regulation of dosage 6. It was therefore impossible to

standardize the results 7 and, attempts at the conquest of pain were sporadic 8.

In the Middle Ages, Christian Europe was in a state of intellectual stagnation 9 and the theological

doctrine that pain serves God's purpose and must not be alleviated militated against the improvement

in methods of narcosis. Nuland 10 points out that the Middle Ages in Europe were dark ages so far as

advances in the pharmacology of anesthesia were concerned. In Europe, that period is usually

referred to as the Dark Ages when no progress was made in medical science. However, the situation

in the East was different 11 In the East, with the firm establishment of the Muslim supremacy between

the 9th and 16th centuries; the study of medicine along with other branches of science revived and

acquired a truly scientific nature. Many Muslim Scholars like Ibn Sina (Avicenna) 12 Al-Razi, Al-

Baghdadi and Ibn al-Quff 13

, paid great attention to the phenomenon of pain. They attributed it notonly to a breach of continuity, as stated by Galen, but also to a sudden change of temperament with

or without abnormal humors. Hence, for pain relief, they stressed the treatment of the underlying

cause and they subsequently developed a large number of analgesics with variable modes of action.

The anesthetics they described included a wide range of medical plants as well as ice or very cold

iced water as an efficient and safe mode of local anesthesia even though there might be an increase

in the pain at the beginning. Refrigeration anesthesia which is considered by some to be a modern

discovery, thus, had its origin in the medicine of the middle ages. They discovered the anesthetic

action of the various medical plants used to a specific sensation property of variable strength, and

thus according to Ibn Sina (Avicenna), 14 opium is the most powerful, then mandrake, papaveris,

6 Keys T, The history of surgical anaesthesia, New York: Schuman's, 1945, Nuland SB, The origins of anaesthesia. Birmingham: The Classics ofMedicine Library, 1983.7 Keys T, The history of surgical anaesthesia, New York: Schuman's, 1945.Tallmadge GK, "Some anaesthetics of antiquity". J Hist Med All Sci 1946:1: 515-20. Horine FE, "Episodes in the history of a naesthesia". J Hist Med All Sci 1946; 1: 521-6.8 Kitz RJ, Vandam LD, "A history and the scope of anaesthetic practice". In: Miller RD ed., Anaesthesia vol 1, 2nd ed., New York: ChurchillLivingstone, 1986, 3-25. 9 Nuland SB, The origins of anaesthesia. Birmingham: The Classics of Medicine Library, 1983. Cumston C G, An introduction to the history ofmedicine from the time of the Pharoahs to the end of the XVIII Century. London: Dawsons, 1968. Bickers W, "Adventures in Arabian Medicine". J Roy

Coll Surg Ir 1969; 5: 5-14. Campbell DC, Arabian medicine and its influence on the Middle Ages . Amsterdam: Philo Press, 1974, (reprint).10 Nuland SB, The origins of anaesthesia. Birmingham: The Classics of Medicine Library, 1983.11 Cumston CG, "An introduction to the history of medicine from the time of the pharoahs to the end of the XVIII century". In: Islamic medicine ,London: Dawsons of Pall Mall, 1968: 23-26, 185-212. Dickinson EH, The medicine of the ancients. Liverpool: Holden, 1875: 37-39. Kirkup JR, "Thehistory and evolution of surgical instruments. Introduction". Ann R ColI Surg Eng 1981; 63: 279-285. Campbell DC, Arabian medicine and itsinfluence on the middle ages. 1st edition (reprint), Amsterdam: Philo Press, 1974: pp. XI-XV.12 Ibn-Sina, Kitab aI-qanun fi al-tibb , Beirut: Dar Sadir, reprint of Cairo Boulak edition, 1877.13 Al-Razi, Kitab al-Hawi fi al-tibb (Rhazes Liber Continens) , vol 23, 1st ed., Hyderabad: Osmania Oriental Publications, Osmania University, 1961.De Moulin D, "A historical phenomenological study of bodily pain in Western man". Bull Hist Med 1974; 48: 540-70. AI-Baghdadi, Kitab aI-mukhtarat fi al-tibb , vols 1-4, 1st ed. Hyderabad: Osmania Oriental Publications, Osmania University, 1942-1944. Ibn al-Quff, AI-'Umda fi al-jiraha ,vol 1-2, 1st ed. Hyderabad: Osmania Oriental Publications, Osmania University, 1936.14 Ibn-Sina, Kitab aI-qanun fi al-tibb , Beirut: Dar Sadir, reprint of Cairo Boulak edition, 1877.


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henbane or hyocyamus, hemlock, solanum and wild lettuce. These drugs, especially opium, were

used as local anesthetics in dental cases, earache, eye pain and joint pain (especially in gout).

In dentistry, they used opium, mandrake root or henbane juice in the form of pastes, patches or

fillings. Gargles from decoctions of mandrake root, henbane root or seeds or the root of solanum

were also used. Opium drops in rose oil, infusion of root of solanum, decoction of papaveris, oil or

juice of henbane and angelica juice were used for earache. The relief of eye pains was achieved by

either using dressings from mandrake leaves or mixing the eye medicines with mandrake tears or

juice of hemlock. Embrocations of the juice of henbane leaves or seeds were also used on the eye

and, for joint pains, dressings from mandrake leaves or embrocations from opium, hemlock, henbane

or cannabis.

In addition, as it is seen that severe pain may lead to death, the soporific action of these drugs was

employed especially pre-operatively in the cases of amputation, cautery, circumcision and

lacerations. They were administered by ingestion, inhalation or rectally. Infusions of solanum,

cannabis, opium and mandrake were given orally or rectally on a plug which has to be changed

hourly. Opium, mandrake and henbane were also used by inhalation in the form of odorants. The

wild lettuce has a mild soporific effect. It was used either fresh or boiled as an adjuvant to any of the

previous medications or alone in cases of insomnia. The physicians of Islamic civilization were

familiar with surgery and have practiced different kinds of surgical procedures such as amputation,

tonsillectomies, excision of tumors, and in some instances describing technical details. 15

This extent of surgery was not performed without some kind of pain allayment. In addition, one of

the reasons why the Muslims could make their way into the field of anesthesia was the fact that the

concept of pain as a punishment from God had no place in their belief and tradition.

There is evidence that the Muslims used to administer sedatives and analgesic mixtures before a

surgical operation. A question from Avicenna reads "A patient who wants to have an amputation ofone of his organs must have a drink prepared from a mixture of Mandagora and other sleeping

15 HADDAD, F.S.: "Alo-Aldeen Ibnul Nafiess", M.E.J. Anaesth. 4:223-224, 1974.


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drugs". Other plants used for the same purpose were Indian cannabis (Hashish), Opium poppies (El-

Khishkash), Shweikran (Hemlock), Bhang and hyoscyamus. 16

The Muslims scientists are also credited for the introduction of inhalational anesthesia by using the

then called "Anesthetic sponge" or "Sleeping sponge". A quotation from Sigrid Hunke's book reads:

The science of medicine has gained a great and extremely important discovery and that is the use of

general anesthetic s for surgical operations, and how unique, efficient, and merciful for those who

tried it the Muslim anesthetic was. It was quite different from the drinks the Indians, Romans and

Greeks were forcing their patients to have for relief of pain. There had been some allegations to

credit this discovery to an Italian or to an Alexandrian, but the truth is and history proves that, the art

of using the anesthetic sponge is a pure Muslim technique, which was not known before. The sponge

used to be dipped and left in a mixture prepared from cannabis, opium, hyoscyamus and a plantcalled Zoan" 17.

These physicians not only determined the required dose in each drug precisely but also were able to

fix the length of time which the anesthesia was to last with great precision. Avicenna for example,

gave the dose of one 'mithkal' of mandrake for 3-4 hours of general anesthesia. Unlike Paulus, Ibn

Sina, AI-Razi, Al-Baghdadi, Ibn EI-Quff and Ibn al-Baytar in the light of their own experiments and

observations, described the general and special botanical characters of the plants in detail as well as

indicating their habitats and what was best selected from each. They also specified methods for

obtaining the active ingredients whether as juice or in the various medical forms that can be prepared

as infusions, decoctions or dressings. Both of the historians, Ibn Khallikan in the 13th century, and

Ibn Kathir in the 14th century, documented that Urwa Ibn AI-Zubair in the beginning of the 8th

century developed leg gangrene for which amputation was required. The doctors of the Ummayad

Caliph Al-Walid Ibn Abdel Malek in Damascus offered him Al-Murquid to be put to sleep for the

operation. Literally, the word 'Al-Murquid' in Arabic means a drug that induces deep sleep. Evidence

16 GRAY and NUNN: "General Anaesthesis". Third edition, Vol. I, PP. 708-710, Butterwerths, 1971.17 AVICENNA: "El-Kanun Fi'l Tibb". Vol. II -371, Vol. III-132, 134, 137, 229. A newly print by El-MusannaBookshop, Baghdad, Offset from Boulak print (1294 A.H.) and 1877 A.C.).


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about the popularity of this anesthetic comes from finding entries about Al-Murquid in four general-

purpose Arabic language dictionaries compiled during that era 18.

Al-Murquid was used either by ingestion or inhalation or rectally. In the form of infusion, they used

particular types of solanum, cannabis, opium and mandrake by ingest ion. The last three drugs were

also administered rectally on a plug which had to be changed hourly. On the other hand, opium,

mandrake and henbane were also used by inhalation in the form of odorants. As wild lettuce has a

mild soporific effect it was used, whether fresh or boiled, as an adjuvant to any of the previous ones

or in cases of insomnia 19. They not only precisely determined the required dose of each drug but also

they were able to fix the length of time which the anesthesia was to last with great precision, for

example, Ibn Sina 20 gave a dose of one 'mithkal' of mandrake for 3-4 hours of general anesthesia .

The knowledge and practice of anesthesia reached its peak in the beginning of the 14thcentury as evidenced in Ibn al-Quff's book on surgery Al-'Umda Fi-'l-Jiraha (the mainstay in

surgery). Different than Paulus of Aegineta 21, Ibn al-Quff gave detailed information in his book on

the phenomenon of pain and clearly stated that pain relief during surgery should be the responsibility

of a second medical man other than the surgeon performing the operation. In this regard physicians

were called to look after the matter of surgery after giving the pain relieving drug Al-Murquid and

its effect on the patient and the surgeon (Al-Jaraaehi) is then allowed to perform the operation

without any hindrance. This represents the first report, in the literature, on the role of the

anesthetists. They also described the specific actions and side effects on the various systems of the

body and stated with great accuracy the required dosage from juice, bark or decoctions as well as the

toxic dose. Finally, they outlined the action of antidotes, adjuvant and alternative remedies.

The development of anesthesia during that period by reviewing the following books: Al-Hawi

fit-tibb (The Continence , Al-Qanun fi-al-tibb (The Cannon of Medicine), Al-Tasrif , Al-Mukhtarat fit- 18 lbn Khallikan, Wafayat al-a'yan , ed. Mohamed Mohyuldeen, Maktabt al-Nahda, 1948: 418-428. lbn Khathir, Al-bidaya wa-'l-nihaya , 3rd ed. Abu Mohem A. et al. eds. Beirut: Dar al-kutub al-'ilmiya, 1987; 4: 108. Mohamed binYagab AI Firouz-Abadi, Al-Qamus al-muhit , 3rd ed. Cairo: AI-Matba'a al-Masriya, 1933; I: 295. Ibn Manzur, Lisan al-'Arab , AI-Kabir A et al. eds. Cairo, Egypt: Dar aI-Ma'arif, 3: 1206; Ibn al-Jawzi, Sayd aI-Khatir , Abdul Kader A, ed.Beirut: Al-maktaba 'l-'ilmiya (undated): 18. Al-Razi, Muktamal-Sihah . Beirut: Dar al-kitab al-'arabi, 1981: 252. AI-Zamakhshari, Asas al-Balagha. Beirut: Dar al-fikr (undated): 244.

19 Al Mazrooa AA, Abdel-Halim RE. "Anaesthesia 1000 years ago". In: Atkinson RS, Boulton TB, eds. The history ofanaesthesia. London, New York: Royal Society of Medicine Services and the Parthenon Publishing Group, 1989: 46-48.20 Ibn Sina, Kitab aI-qanun fi al-tibb , op. cit., vol. 1: pp. 334; vol. 2: pp. 200-205.21 lbn al-Quff, AI-'Umda fi 'I-jiraha , op. cit., vol. 2: pp. 104-105; vol. 1: p. 205. Paulus of Aegineta, The seven books ofPaulus of Aegineta , 6th book. Adams F, trans. London: Sydenham Society, 1846: pp. 1-3.


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tibb , Al-'Umda Fil Al-Jiraha , and Al-Taysir . The authors of these books are respectively Al-Razi, Ibn

Sina, Al-Zahrawi, Al-Bagdagi, Ibn al-Quff and Ibn Zuhr. Those authors were medical scholars who

lived in the period between the 9th and the 14th centuries. Their contribution to pain relief has been

recently evaluated 22. In the following section, we will evaluate their contributions to anesthesia and

resuscitation.

The Muslims must be given the credit for developing the science of botany 23. Ibn al-Baytar is one of

the greatest Arabi botanists 24 his book Al-Jami' Al-Kabir is the most original among the Arabic

materia medica texts of the mediaeval period. Arabic materia medica had a considerable impact on

European herbal and antidotarium authors from the 12th to the 17th century. 25 The works of

Constantine are plagiarism or skillful disguised translations from the Arabic treatises. The medicinal

remedies reported by Dioscorides are thus of Islamic origin.26

The same may be said of the work of Celsus which was hardly noticed by the Greeks and overlooked

in the middle Ages 27. In the section on emollients (vol. 2), Celsus describes one of them as the

invention of a certain Arab, and some of his recipes are based on Arabic materia medica with its

tables of weights and measures (pound, dirham and dinarium or dinarii). The only conclusion

22 AI-Razi, Kitab al-Hawi fi al-tibb , op. cit., vol.3: pp. 225-233; vol. 23: pp. 225-242. Ibn Sina, Kitab aI-qanun fi al-tibb ,

op. cit., vol. 1: pp. 334; vol. 2: pp. 200-205. AI Zahrawi, Al-Tasrif liman 'agaz 'an-al-ta'lif . In: Spink MS, Lewis CL, edsand trans. Albucasis on surgical instruments . London: Wellcome Institute of the History of Medicine, 1973: 338-339.AI-Bagdadi, Kitab aI-mukhtarat fi al-tibb , op. cit., vol. 1: p. 141; vol. 3: p. 190. lbn al-Quff, AI-'Umda fi 'I-jiraha , op.cit., vol. 2: pp. 104-105; vol. 1: p. 205. Ibn Zuhr, AI-Taysir fi-'l-mudawat wa-'l-tadbir , Alkhoury M, ed. Damascus: TheArabic Organisation for Education, Culture and Science, 1983: 149-155. Al Mazrooa AA, Abdel-Halim RE."Anaesthesia 1000 years ago". In: Atkinson RS, Boulton TB, eds. The history of anaesthesia. London, New York: RoyalSociety of Medicine Services and the Parthenon Publishing Group, 1989: 46-48.

23 Desnos E, "The history of urology up to the latter half of the thirteenth century". In: Murphy LJT, ed., The history ofurology. Springfield: Thomas, 1972. Dickinson EH, The medicine of the ancients. Liverpool: Holden, 1875. Margotta R,in: Lewis, P, ed., An illustrated history of medicine . Feltham: Hamlyn, 1968.24Cumston C G, An introduction to the history of medicine from the time of the Pharoahs to the end of the XVIII Century. London: Dawsons, 1968. Ibn al-Baytar, Jami' mufradat al-adwia wa-'I-aghzia (A Dictionary of simple drugs), MS No.3979, Chester Beatty Library in Dublin, Microfilm at Imam Ibn Saud University Library, Riyadh. Hamerna SK."Tareekh Al-Tibb Wa Assaidala End Al-Arab" . Vol 1-2. Cairo: 1967. Ibn Abi Usaybi'a, 'Uyun al-anba' fi tabaqat aI-atibba' (The sources of the knowledge of classes of doctors). Beirut: Dar Maktabat al-Hayat, 1965.25 Cumston C G, An introduction to the history of medicine from the time of the Pharoahs to the end of the XVIIICentury. London: Dawsons, 1968. Campbell DC, Arabian medicine and its influence on the Middle Ages . Amsterdam:Philo Press, 1974, (reprint). Garrison FH, An introduction to the history of medicine , 3rd ed. Philadelphia and London:Saunders, 1924. Dunlop DM, "Arabic medicine in England". J Hist Med 1956; 2: 166-82.26 Cumston C G, An introduction to the history of medicine from the time of the Pharoahs to the end of the XVIIICentury. London: Dawsons, 1968.27 Guthrie D, A history of medicine. London: Thomas Nelson, 1945. Dunlop DM, "Arabic medicine in England". J Hist

Med 1956; 2: 166-82.


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possible is that the writings of the Muslim scholars in their Latin form influenced European medical

thought over a very considerable period.

In that era they also realized the importance of monitoring during anesthesia as, a third medical man

used to be present putting a finger on the pulse during the operation 28. It is interesting to note this

method of monitoring, by palpating the pulse is still practiced nowadays and is referred to in

anesthesia text-books as a simple non-invasive method. Ibn Abi Usaybi'a in the 13th century in his

book of medical biographies 'Uyun al-anba' fi-tabaqat aI-atibba' documented a case in which a

critically ill patient already pronounced dead was successfully resuscitated by the physician Saleh

Ibn Bahla who bring forth that the patient still responded to painful stimuli, then with the use of

bellow, insufflated air and soap root powder into his nose. According to Jaser, this clinical case

report documented the use of bellows for respiratory resuscitation 900 years before it was firstreported in Europe. The contributions of the above mentioned authors were translated into Latin as

early as the middle of the 12th century and greatly influenced the European mediaeval schools of

medicine well into the 18th century 29.

Conclusion

Science has no native home of its own and every person has the right to ask for it. When the talents

and circumstances exist, new horizons can be discovered. The Muslims are first in the list of thenations who had the honour of holding the torch of civilization for quite a while and made a great

contribution to basic sciences, upon which the modern technology and progress is raised. In the field

of anesthesia and resuscitation, the contribution of Islamic civilization is enormous and its influence

on the western civilization is profound and discoveries made have laid down the foundation of

28 Sigrid Hunke, Allah's sonne uber dem abendland unser Arabische erbe , 6th ed. Baidoon F, Dosoky K, Arabic trans.Beirut: Dar Al-afaq aI-jadida, 1981: 239. 29 Ibn Abi Usaybi'a, 'Uyun al-anba' fi tabaqat aI-'atibba' , Nizar Reda, ed., op. cit., pp. 475-477. Jaser MT, "Anaesthesiain the history of Islamic medicine". In: Atkinson RS, Boulton TB, eds., The history of anaesthesia. London, New York:Royal Society of Medicine Services and the ParthenoQ Publishing Group, 1989: 48-50. Ullman M., Islamic medicine (Islamic Surveys Series, N 11). Edinburgh: Edinburgh University Press, 1978: 52-54. Freind J., Histoire de la mdecinedepuis Galien jusqu'au commencement du seizime sicle. Etienne Coulet, trans. Leyden: Langerak 1727; 3: 1-80.Gruner OC. A Treatise on the Canon of Medicine of Avicenna incorporating a translation of the first book. London:Luzac, 1930: 18. Montagnani CA. "Paediatric surgery in Islamic medicine from Middle Age to Renaissance". In:Rickham PP, ed. Historical aspects of paediatric surgery. Progress in Paediatric Surgery 1986; 20,39-51. Radbill SX."The first treatise on paediatrics". Am J Dis Child 1971; 122: 369-376. Shah MH. The general principles of Avicenna'sCanon of medicine. Karachi: Naveed Clinic, 1966: iii


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modern practice. Today the Islamic nations are invited to contribute more and more and they are

quite capable to do right that again.

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Researchpaper Anesthesia Drugs in the Medieval Muslim Era