ANESTHESIA. — The word (from Greek ἀνέγχος = sensation) signifies a general lack of sensitivity and is commonly used by non-medical persons as a synonym for analgesia (ἀνέγχος = pain), that is, a lack of painful sensation. Thus, the term "anesthetics" is used indiscriminately to denote substances (opium and its derivatives, certain sulfur compounds, cocaine, chloral, chloroform, nitrous oxide, etc.) that diminish or eliminate pain, whether as analgesics or as true anesthetics.
We therefore distinguish between local anesthesia, where insensitivity affects only a part of the body (properly speaking, analgesia), and general anesthesia, where insensitivity extends to the entire body with a state of general sleep and loss of consciousness. Most anesthetics also have an extramedical use and are employed to induce states of intoxication and unpleasant sensations: euphoria of excitement (cocaine, ether, etc.) or euphoria of passivity (opium). In this case, they are referred to as narcotics (v.).
1. — MEDICAL PRACTICE AND HISTORY. — Anesthesia may be considered from various perspectives: anesthesia induced artificially (especially in surgical operations); anesthesia linked to preternatural and supernatural factors; and anesthesia produced by pathological factors according to the interpretation of modern psychiatrists.
1. Surgical anesthesia, whether local or general in the form of narcosis, was attempted by the ancients through various procedures and substances of highly uncertain action (compression, ligation, the Memphite stone, crocodile leather ash, etc.). More evident in its effects was the use of plant juices with narcotic properties (opium, mandrake, belladonna, henbane, etc.). With these substances, a "soporific confection" was prepared, used in the 12th and 13th centuries (Nicolò Salernitano, Teodorico de' Borgognoni), administered either via the *spongia somnifera* (a sponge impregnated with the aforementioned juices and applied to the patient’s mouth and nose at the time of surgery) or orally. This unreliable method was abandoned due to difficulties in dosage (especially with the sponge), and anesthesia remained a mere aspiration. In the 16th century, an attempt was made at local anesthesia through cold (M. A. Severino). In the 17th and 18th centuries, the "cells of cold" (M. A. Severino) were used to induce a kind of general anesthesia by intoxicating the patient with aqua vitae and repeatedly striking his head. In the 19th century, true anesthesia began with Horace Wells’ failed first attempt using nitrous oxide (laughing gas), later taken up and successfully implemented in 1863 by J. H. Smith. This was followed by the use of sulfuric ether (G. Jakson and W. T. G. Morton), first applied in 1846, and chloroform, initially used in obstetrics in 1847 on the advice of Waldie by J. Simpson. Local anesthesia was practiced through injections of morphine and later cocaine after the discovery of these alkaloids (1816 and 1884) and the invention of the hypodermic syringe.
In 1885, I. L. Corning introduced spinal anesthesia with cocaine injections, and in 1899, A. Bier performed lumbar anesthesia. Meanwhile, in 1842, J. Braid, based on observations of mesmeric phenomena, had discovered hypnotism, which he applied as an anesthetic (psychic anesthesia), a method that encountered strong opposition. Other forms of anesthesia of secondary importance are omitted here.
2. — ANESTHESIA FROM PRETERNATURAL AND SUPERNATURAL FACTORS. — According to medieval belief, particular states of anesthesia were induced by magical operations or diabolical interventions. Satan himself was thought to have promised sorcerers insensitivity to pain as long as they kept their hair, which led inquisitors to shave the heads of the accused (C. Sprengel), or even the entire body (M. Cumanus).
This belief persists among sorcerers in Malaysia (J. G. Frazer). Special magical potions were also furtively sold to accused persons to help them endure the pain of torture. Cutaneous anesthesia, widespread and limited to the skin’s surface, was, according to medieval legends, a sign of diabolical possession, whether through a pact between an infernal spirit and a sorcerer or through possession occurring without the victim’s consent.
A particular state of analgesia through divine intervention is found in many hagiographical accounts, according to which certain martyrs appeared not to feel the torments of their sufferings, while various holy persons endured the pains of the most cruel diseases, and various mystics felt no pain from pricks or burns. Modern psychiatrists define such anesthesia as a "physiological miracle" (E. Tanzi and E. Lugaro).
3. — ANESTHESIA FROM PSYCHIC FACTORS. — This can be induced by states of extreme emotion (quarrels, war episodes, catastrophes, etc.) and may last for several hours. In certain magical-religious ceremonies of primitive peoples, the sorcerer-priest—and, through psychic contagion, those present—reach such a state of exaltation that they can inflict wounds upon themselves, pierce their cheeks with sharp irons, and feel no pain.
Many diseases produce anesthesia, particularly certain mental illnesses. Leprosy, for instance, causes it to such an extent that this symptom was considered pathognomonic of the disease and was one of the signs used by leper tribunals to decide on the confinement of patients in leper hospitals (v. LEPROSY AND LEPER HOSPITALS). Among mental illnesses, apart from severe melancholia, depressive states of progressive paralysis, epilepsy, catastrophic states, amentia, senile dementia, alcoholism, etc., hysteria produces localized and patterned areas of anesthesia, such as glove-shaped or stocking-shaped zones; this characteristic can easily be confused with the capricious zones of anesthesia found in those supposedly possessed by the devil.
II. — MORAL DOCTRINE. — Natural morality has no objection to the use of anesthetics to mitigate or abolish pain so that the sufferer may find relief or undergo necessary or advisable surgical procedures. The argument from the example of Jesus Christ, who during His Passion chose to endure the immense weight of His sufferings in their entirety, does not invalidate the use of anesthetics. A Christian is free not to resort to anesthesia, to embrace, preserve, or even desire pain for its supernatural value of expiation and impetration; we have countless examples of this in hagiography. However, such an attitude cannot be established as a universal law; not everyone is capable of it, and even for those who are, the physician must act with prudence and moderation in consenting, foreseeing the possible drawbacks that might arise. Even here, the body does not always correspond to the desires and aspirations of the soul.
The general principle is therefore this: local or general anaesthesia may be used whenever it is judged opportune for the patient’s well-being. With these cautions, however: a) watch for toxic effects that may result from the anaesthetic; b) when it comes to injections of morphine, cocaine, etc., it is for the physician to determine the dose and frequency, since the patient may easily contract dangerous habits; c) when the anaesthesia is total and thus consciousness is abolished, the patient, before being put to sleep, must put his temporal and above all spiritual affairs in order, since unforeseen or sudden and fatal accidents may occur; d) anaesthesia is licit in obstetrics to the extent that it is not harmful to either mother or unborn child. “One of the chief causes of the limitation of births is the fear of the pains of childbirth, a fear which the woman feels quite naturally, but which is often shared by the husband who cannot bear to see the woman he loves suffer, nor to think that suffering is the price of his own pleasure. Moreover, modern man, especially, thinks it unjust that while efforts are made to alleviate human pains and miseries, no thought is given to alleviating the pains of motherhood” (E. Bonn, pp. 356-57).
For anaesthesia in the agony and in the face of death, V. EUTHANASIA.