ANESTESIA. – The word (from the Greek ἄν περ. and χίοθησις = sensation) means lack of sensitivity in general and is commonly used by non-physicians as a synonym for analgesia (ἄν περ. and ἄκρησις = pain), that is, lack of sensitivity to pain. Thus, the name anesthetics is applied indiscriminately to substances (opium and its derivatives, sulfuric ether, cocaine, chloral, chloroform, nitrous oxide, etc.) that diminish or eliminate pain, whether as analgesics or as anesthetics properly so called.
We therefore have local a. when insensitivity concerns only one part of the organism (properly, analgesia), and general a. when insensitivity extends to the entire organism, with general sleep and loss of consciousness. Most anesthetics also have what may be called an extra-medical use and are employed to produce states of intoxication and pleasurable sensations: euphoria of excitation (cocaine, ether, etc.) or euphoria of passivity (opium). In this case they are narcotics (v.).
1. – MEDICAL PRACTICE AND HISTORY. – A. may be considered from various points of view: a. deliberately 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., both local and general, in the form of narcosis, was attempted by the ancients by means of various procedures and substances whose action was highly uncertain (compression, ligature, Memphite stone, crocodile-leather ash, etc.). More evident in its action was the use of plant juices with a narcotic effect (opium, mandrake, belladonna, henbane, etc.). From these substances there was prepared a “confectio soporis,” used in the 12th and 13th centuries (Nicolò Salernitano, Teodorico de’ Borgognoni), administered by means of the spongia somnifera (a sponge impregnated with the aforementioned juices and applied to the patient’s mouth and nose at the time of the operation), or also given by mouth. After this unreliable method was abandoned because of the difficulty of dosage (especially in the case of the sponge), a. remained merely an aspiration. In the 16th century, local a. by cold was attempted (M. A. Severino). In the 17th century, and especially during the Thirty Years’ War, a kind of general a. was induced by getting the patient drunk with brandy and repeatedly striking his head. In the 19th century true a. began with Orazio Wells’s attempt, unsuccessful at the first trial, using nitrous oxide (laughing gas), later resumed and successfully carried out in 1863 by J. H. Smith. This was followed by the use of sulfuric ether (G. Jakson-W. T. G. Morton), first applied in 1846, and of chloroform, first used in obstetrics (1847), on Waldie’s advice, by J. Simpson. Local a. was practiced with injections of morphine, and later of cocaine, following the discovery of these alkaloids (1816 and 1884) and the invention of the hypodermic syringe.
In 1885 I. L. Corning described spinal a. using injections of cocaine, and in 1899 A. Bier performed lumbar a. Meanwhile, in 1842 J. Brai, on the basis of his observation of mesmeric phenomena, had discovered hypnotism, which he applied as an anesthetic (psychic a.), a method that met with strong opposition. Other forms of a. of secondary importance are omitted.
2. A. from preternatural and supernatural factors. – According to medieval belief, particular states of a. were brought about by magical operations or diabolical interventions. Satan himself was said to have promised sorcerers that he would make them insensitive to pain as long as they possessed their hair; consequently, inquisitors had the accused’s heads shaved (C. Sprengel), or even their entire bodies (M. Cumanus).
This belief still exists today among the sorcerers of Malaysia (I. C. Frazer). Special magical potions were also secretly sold to the accused so that they might endure the pain of torture. A., widespread yet limited to the surface of the skin, was, according to medieval legends, a manifestation of diabolical possession, whether effected through a pact between an infernal spirit and a sorcerer or through possession occurring without the possessed person’s consent.
A particular state of analgesia through divine intervention appears in many hagiographical narratives, according to which certain martyrs showed that they did not feel the torments and tortures inflicted upon them; various holy persons did not feel the pains of the most gnawing illnesses; and various ecstatics did not feel pricks or burns. Modern psychiatrists define such a. as a “physiological miracle” (E. Tanzi and E. Lugaro).
3. A. from psychic factors may be induced by states of extremely intense emotion (fights, episodes of war, catastrophes, etc.) and may last for several hours. In certain magical-religious ceremonies of primitive peoples, the priest-sorcerer, and through psychic contagion those present as well, reach such a state of exaltation that they inflict wounds upon themselves and pierce their cheeks with sharp instruments without feeling pain.
Many diseases produce a., particularly certain mental illnesses. It is produced, for example, by leprosy, to such an extent that this symptom was considered pathognomonic of the disease and constituted one of the signs used by leper tribunals to decide on the internment of the sick in leprosaria (v. LEBBRA E LEBBROSARI). Among mental illnesses, in addition to severe melancholia, the depressive states of progressive paralysis, epilepsy, catatonic states, amentia, senile dementia, alcoholism, etc., hysteria is characterized by analgesia in limited and patterned areas, in the form of a glove, a boot, and so forth; this characteristic makes possible confusion with the capricious areas of a. found in those possessed by the devil.
The general principle is therefore this: one may resort to local or general anesthesia whenever it is judged appropriate for the patient's well-being. With the following cautions, however: a) monitor the toxic effects that may result from anesthesia; b) when it is a question of injections of morphine, cocaine, etc., it is for the physician to establish the dosage and frequency, because it is easy for the patient to develop dangerous habits; c) when the anesthesia is total and consciousness is therefore 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 incidents might occur; d) anesthesia is also licit in obstetrics to the extent that it is harmful neither to the mother nor to the unborn child. « One of the principal causes of the limitation of births is fear of the pains of childbirth, a fear that the woman logically has, but which is often felt also by the husband, who can neither see the woman he loves suffer nor think that suffering is like the price of his enjoyment. Moreover, modern man, above all, thinks that, while efforts are made to alleviate human pains and miseries, it is not right then to fail to consider alleviating the pains of motherhood » (E. Bonn, pp. 356-57).
For anesthesia in agony and in the face of death, V. EUTANASIA.