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Eat Some Lettuce and See Me in the Morning: The Endless Search for Pain Relief

Source: Pain Medicine News

A.J. Wright

 

One constant throughout human history, unlimited by time or place, has been the search for pain relief. We have reached a point in the modern world where anesthetics, narcotics, over-the-counter pain relievers, etc., can give some measure of comfort in many painful situations. Yet, the search for improvement continues in neuroscience and pharmacology.

 

The discovery, in the 1840s, that ether and chloroform vapors could offer significant pain relief during surgery enabled development of the idea in the West that pain did not always have to be endured. Yet, a vast literature created over the centuries and around the world documents earlier, less successful efforts at pain relief. Contemporary research in ancient and medieval manuscripts continues to uncover medical practices from cultures around the world, including recipes for treatments of many types of pain.

 

Although published in 1946, Edgar S. Ellis’ book “Ancient Anodynes: Primitive Anaesthesia and Allied Conditions” is an excellent overview of the field. He covers pain relief by physical, psychological, inhalation and local methods. He cites many examples from the past: biological materials such as the poppy, belladonna, cannabis, hellebore, hemlock, garlic, curare and mandrake; various uses of alcohol; inhalation of different substances and mixtures; and snow or cold water.

 

One interesting effort that Ellis notes is the “sleeping apple,” a ball made of a mix of substances and described by authors ranging from the Roman physician Dioscorides in the first century ad to Italian scholar Giambattista della Porta in the 17th century. As he catalogs this enormous number of pain relief methods, Ellis often expresses his skepticism about their efficacy. Perhaps many had placebo value.

 

A method similar to the sleeping apple was the “soporific sponge,” or spongia somnifera. The sponge contained a mixture of herbals and was placed over the patient’s face or under the nostrils prior to surgery. Inhalation of the fumes allowed painless surgery while the patient was unconscious. Herbs used included poppy, hemp, henbane and mandragora.

 

Recipes for this method from the Arab world date back to the 11th century; others appeared in Italy, Germany and Spain into the 16th century. The earliest known example is from the Bamburg Antidotarium of the ninth century. This collection of medical recipes contains a very specific one for the sponge. Ingredients included an ounce of opium, eight ounces of mandrake leaf juice, three ounces of henbane juice, and green juice from hemlock. Mixed with an appropriate amount of water, this concoction soaked into a sponge that was allowed to dry. When needed, the sponge could be re-soaked in warm water for an hour, and was then ready to be placed under a patient’s nostrils for pain relief.

 

Sleeping potions of various kinds found their way into medieval and Renaissance literature, as well. Boccaccio’s “The Decameron,” Shakespeare’s “Othello” and “Antony and Cleopatra,” Marlowe’s “The Jew of Malta” and “The Arabian Nights,” among others, feature such plot devices. How widely they were actually used in medicine remains unknown. For instance, the great 16th-century French surgeon Ambroise Paré did not use any such pain-relieving methods. One would imagine that the spread of the recipe books throughout Europe during these centuries would have alerted physicians to the sponge and other pain relievers, if they had been truly effective.

In 1847, the Lancet published an abstract of an article by a French physician named Dauriol, who claimed to have used a sponge recipe to achieve surgical anesthesia. In 1888, British physician Benjamin W. Richardson used a mandrake–alcohol mix for experiments on pigeons, rabbits and his own lips, noting a gentle sleep in the animals—unless too high a dose produced death. Scopolamine and other alkaloids in the plant no doubt helped produce the effects that he noted.

 

Medical historian Plinio Prioreschi is a modern-day researcher who expressed skepticism about the sponge’s effectiveness in producing anesthesia for surgery, in a 2003 article in Medical Hypotheses.

In their research in Old and Middle English scientific and medical manuscripts, Linda Voigts and Patricia Kurtz found some 40 anesthetic recipes. Thirteen of them apparently had limited circulation due to what must have been recognized as their dangerous ingredients. However, they found 27 examples of a brief recipe for “a drynke that men callen dwale to make a man to slepe whyle men kerven him.”

 

In their book chapter, Voigts and Robert P. Hudson note that the word “dwale” could mean several things in Middle English: deception or delusion; a dazed or unconscious condition; a fool; the nightshade plant; or a soporific drink. The last meaning is used by Chaucer in “The Reeve’s Tale.”

 

The drink recipes are fairly consistent across the examples that the researchers found. Ingredients included swine gall, hemlock juice, wild nept, lettuce, poppy, henbane and vinegar. After boiling, the mixture could be stored until needed, after which three spoonfuls were to be mixed with a gallon of wine. The authors’ discussion of these ingredients, and the relationship of this recipe to others, is fascinating.

 

An example of a surgical anesthetic used in Japan well before 1846 has become well known in the West in recent decades. Seishu Hanaoka was a surgeon born in 1760 and died in 1835. Hanaoka improved herbal recipes for pain relief that came from China to the point where he was able to use the oral anesthetic in major surgeries.

His formula is known as Tsusensan: two main ingredients were mandarage of the Datura genus and Aconitum japonicum. The patient drank the hot liquid, and in two to four hours was ready for surgery. The effects lasted six hours or longer depending on the dose. Hanaoka left records of dozens of surgeries, including many for breast cancer. His illustrated “Surgical Casebook” is available on the U.S. National Library of Medicine’s website (www.nlm.nih.gov).

 

As with so many things, we tend to look at past efforts at pain relief with amusement. Yet, many of these recipes contained active ingredients recognized much later. Visitors from the past would no doubt be amazed at what we moderns can do to relieve pain, and they could easily appreciate our continuing efforts to find even better methods than we have now.