Anesthesia

ANESTHESIA. - The word (from Greek ἄν priv. and αἴσθησις = sensation) means absence of sensitivity in general and is commonly used by non-physicians as a synonym for analgesia (ἄν priv. and ἄλγησις = pain), that is, absence of pain sensitivity. Thus by the name of anesthetics are indicated indiscriminately substances (opium and derivatives, sulfuric ether, cocaine, chloral, chloroform, nitrous oxide, etc.) that diminish or make pain disappear, whether as analgesics or as anesthetics properly so called.

We shall therefore have local a., if the insensitivity concerns only one part of the organism (properly analgesia), and general a., if the insensitivity extends to the whole organism with general sleep and loss of consciousness. Most anesthetics also have a use that may be called extramedical and are employed to produce states of intoxication, pleasant sensations: euphoria of excitation (cocaine, ether, etc.) or euphoria of passivity (opium). In this case they are designated by the name of narcotics (v.).

1. - MEDICAL PRACTICE AND HISTORY. - A. can be considered under various aspects: a. artificially induced (especially in surgical operations); a. connected with preternatural and supernatural factors; and a. produced by pathological factors according to the interpretation of modern psychiatrists.

1. Surgical a., whether local or general, in the form of narcosis, was attempted by the ancients by means of various procedures and substances of very uncertain action (compression, ligature, Memphis stone, ashes of crocodile leather, etc.). Of more evident action was the use of plant juices with a stupefying effect (opium, mandrake, belladonna, henbane, etc.). With these substances a "confectio soporis" was compounded, used in the 12th and 13th centuries (Nicholas of Salerno, Theodoric of Borgognoni), administered by means of the spongia somnifera (a sponge impregnated with the aforesaid juices and applied to the mouth and nose of the patient at the moment of the operation) or else given by mouth. Once this unreliable method was abandoned because of difficulties of dosage (especially in the spongia), a. always remained in the state of an aspiration. In the 16th century a local a. with cold was attempted (M. A. Severino). In the 17th century, and especially during the Thirty Years' War, a kind of general a. was resorted to, by intoxicating the patient with aqua vitae and having him repeatedly strike his head. In the 19th century true a. began with the attempt, failed at the first experiment, of Horace Wells by means of nitrous oxide (laughing gas), taken up again and put into practice in 1863 by J. H. Smith. There followed the use of sulfuric ether (G. Jackson-W. T. G. Morton), applied for the first time in 1846, and of chloroform, used first in obstetrics

(1847), on the advice of Waldie, by J. Simpson. Local a. was practiced with injections of morphine, and then of cocaine, after the discovery of these alkaloids (1816 and 1884) and after the invention of the injection syringe.

In 1885 J. L. Corning indicated spinal a. with injections of cocaine, and in 1899 A. Bier practiced the lumbar one. In 1842 J. Braid, on the basis of observation of mesmeric phenomena, had meanwhile discovered hypnotism, which was applied by him as an anesthetic (psychic a.), a method that met with serious opposition. Other forms of a. of secondary importance are omitted.

2. A. from preternatural and supernatural factors

Particular states of a., according to medieval conviction, were provoked by magical operations or by diabolical interventions. Satan himself would have promised sorcerers to render them insensitive to pain as long as they had their hair, wherefore the inquisitors had the head of the accused shaved (C. Sprengel) or even the whole body (M. Cumanus).

Such a conviction exists even today among the sorcerers of Malaysia (J. G. Frazer). Special magical potions were also sold secretly to the accused in order to make them endure the pain of torture. A., spread over and limited to the cutaneous surface, was, according to medieval legends, a demonstration of diabolical possession, whether effected by means of a pact between an infernal spirit and a sorcerer, or through possession that occurred without the will of the possessed.

A particular state of analgesia through divine intervention emerges from many hagiographic narratives, according to which some martyrs showed that they did not feel the torments of tortures and supplices, various holy persons the pains of the most gnawing diseases, and various ecstatics the punctures or burns. Such a. is defined by modern psychiatrists as a "physiological miracle" (E. Tanzi and E. Lugaro).

3. A. from psychic factors can be provoked by states of very vivid emotion (brawls, wartime episodes, catastrophes, etc.) and can last even several hours. In certain magico-religious ceremonies of primitive peoples the priest-sorcerer, and through psychic contagion also those present, reach such a state of exaltation as to inflict wounds on themselves, pierce their cheeks with sharpened irons, without feeling pain.

Many diseases produce a., in particular certain mental illnesses. Leprosy produces it, for example, so much so that this symptom was considered pathognomonic of the disease and constituted one of the signs used by the tribunals of lepers to decide the internment of the sick in leprosaria (v. LEBBRA E LEBBROSARI). Among mental illnesses, besides severe melancholia, the depressive states of general paralysis, epilepsy, catatonic states, amentia, senile dementia, alcoholism, etc., in hysteria there is analgesia in limited and figured zones, in the shape of a glove, a boot, etc.; such a characteristic gives the possibility of confusion with the capricious zones of a. of the diabolically possessed.

Adalberto Pazzini

II. - DOTTRINA MORALE. - Natural morality has nothing against having recourse to anesthetics to dull or abolish pain, so that the sufferer may have relief or may undergo the surgical interventions judged opportune or necessary. The argument from the example of Jesus Christ, who especially during the Passion willed to bear in full the immense weight of his sorrows, does not avail against the use of anesthetics. The Christian is free not to have recourse to a., to embrace, preserve, and even desire sufferings, for their supernatural value of expiation and impetration; and we have very many examples of this in hagiography; however, this conduct cannot be erected into a universal law; not everyone feels equal to it; and even for those who might wish it, the physician must show himself prudent and moderate in consenting, foreseeing the inconveniences that could derive from it. Here too the body does not always correspond to the desires and flights of the soul.

The general principle is therefore this: one may have recourse to local or general a. whenever one judges it opportune for the well-being of the sick person. With these cautions, however: a) to watch over the toxic effects that can derive from the a.; b) when it is a matter of an injection of morphine, cocaine, etc., it is up to the physician to establish the dose and frequency, because it is easy for the sick person to contract dangerous habits; c) when the a. is total and consciousness is therefore abolished, the sick person, before being put to sleep, must set his temporal and especially his spiritual affairs in order, because unforeseen or sudden and fatal incidents could occur; d) a. is licit also in obstetrics to that extent which is harmful neither to the mother nor to the unborn child. « One of the major causes of birth limitation is the fear of the pains of childbirth, a fear that the woman logically has, but which is often felt also by the husband who cannot see the one he loves suffer, nor think that suffering is like the price of his enjoyment. Moreover, modern man, above all, thinks that it is not right that while efforts are made to soothe human sorrows and miseries, no thought is then given to soothing the sorrows of maternity » (E. Bonn, pp. 356-57).

For a. in agony and in the face of death, v. EUTANASIA.

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