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An Extremely Selective History of Pain Relief (Volume 1)

Pain relief and the availability of them is very 'in’ right now, with all the talk of the opioid crisis and the very real problems that it presents those with chronic pain.


As well as that, there is always interest in natural pain relief and alternative therapies for various ailments. Unfortunately, often this is an interest for a certain type of person to tell every person with a disability or chronic illness that turmeric (insert other unhelpful suggestion here) will sort them right out.


There are obviously far too many historical ideas of pain relief (many of which are fascinating/ very entertaining) and anaesthetic that I can talk about in one post, so it would be frankly ridiculous if I never revisited this topic again (especially considering how much I love pain relief)


Of the restricted options I’m including in this volume, I’ve written them vaguely chronologically to try and make it easier for myself to keep track of, and hopefully allow a good mix of interesting history and the really quite funny nonsense (of course I don’t mean to mock).

So without further ado, an extremely selective history of pain relief (volume 1).




The Physiognomy of Pain, Plate I, Fear by A. Mosso: Wellcome Collection



Willowbark


Far more sensible than licking a tree, willowbark was used by ancient Chinese and Greek civilisations for pain relief, and was the original source of what we now call aspirin due to the salicylic acid it contains. It is considered the first anti-inflammatory agent, and I think it's safe to say that all of us on NSAIDs thank them for their discovery.


It was used alongside poplar bark and willow shoots to treat rheumatic fever, colds and hemorrhages (can anyone else see an issue with using essentially aspirin to treat a hemorrhage?).


After it had been used as a treatment for thousands and thousands of years, the Royal Society in England noticed, and in 1763 they published a report of 5 years worth of experiments on using dried and powdered willow bark for curing fevers. It was described as “very effective for curing ague” (referring to malaria, or other illness involving a high fever and shivering fits).


After that was considered proof of its effectiveness (thousands of years Vs 5 years but fine), scientists started investigating which of the properties of willow bark made it work so well. They investigated a number of promising compounds, and isolated one that was correct but wasn't all that chemically stable (which I hear is quite important). They then managed to extract the active ingredient, salicylic acid, but that alone cause major gastric irritation (you don't want me to go into further details but my god it sounds unpleasant). After a lot more fiddling, they altered the chemical structure and the resulting acetylsalicylic acid was given the much simpler to spell name, aspirin. Hooray!



Electric Fish


Not as ridiculous as it first sounds, all of us with chronic pain have been recommended TENs machines at some point haven’t we?


Using electrical stimulation for pain dates back to thousands of years BC, in ancient Rome patients with migraines or severe head pain from other causes would be treated with electric fish, in a similar way to how we use TENs machines.


The physician to Emperor Claudius (1st century AD), Scribonius Largus (not a rapper) was an advocate of the procedure and was certainly convinced of its benefits: “To immediately remove and permanently cure a headache, however last longing and intolerable, a live black torpedo is put on the place which is in pain, until the pain ceases and the part grows numb.”


The use of these fish wasn’t just limited to the Romans, the ancient Egyptians used electric rays to treat epilepsy (with no real further notes on if that worked.)

The ancient Greeks used ‘electrotherapy’ so often for pain relief that ‘electric fish’ in Greek is ‘narka’, the root of the word ‘narcotics’.


Later on, but still a long time before household electricity was available, Benjamin Franklin used electrotherapy on a few occasions (at least twice) which actually caused him to have mild retrograde amnesia. He suggested “trying the practice on mad people”, which implies he wasn’t a massive fan.


The 19th century was a ‘golden age’ for electrotherapy as it was used for dental, neurological psychiatric and even gynaecological problems; but it was dismissed after a while for not having a scientific basis and after accusations of being used by quacks. Added to that of course was the improvement in pharmaceuticals, but while we moved onto using those medicines for migraine relief, researchers now are investigating the possibilities of using electronic stimulation therapy for severe and persistent migraines. But if you can’t wait, why not pop down to your nearest aquarium.



Advertisement for 'Savar's Coca Wine.': Wellcome Collection

Coca Leaves


Coca leaves are a very important cultural substance for the people of the Andes. A myth from the area tells the story of a woman called Kuka who was so beautiful, all the men in the empire would instantly fall in love with her. She took advantage of this skill (you go girl) until the Great Inca found out. He ordered her to be sacrificed, cut in half and buried (feels like overkill but whatever), but from her grave grew what they named the coca plant after her, a miraculous plant that relieved pain and suffering and gave the consumer strength and vigour.


While coca leaves are the original source of cocaine (which we'll get to) coca leaf itself is deemed to not cause any long term harm, and has been chewed and brewed in tea by indigenous Andeans for centuries.


The traditional method of chewing it consists of keeping a saliva soaked call of coca leaves in the mouth along with an alkaline substance (like limestone or chalk) which helps extract small amounts of cocaine from the leaves.


Some more recent archaeological evidence seems to show that coca leaves were being chewed alongside lime in Peru around 8000 years ago, but the records we have show the unbroken consumptions of coca leaves around modern day Ecuador beginning with the Valdivian culture (around 3000BC) but not necessarily chewing it.

Based on mummies with supplies of coca leaves, as well as pottery and representations of coca in gold in the Gardens of the Inca in Cuzco, we can date specifically chewing coca to at least the 6th Century AD.

Chewing coca seems to have been limited to the eastern Andes before the Incas were introduced to it.


In later years it was seen to have divine origin and so was limited for use by the nobles and upper classes (typical) by the Topa Inca (1471-1493) but it became more available to all as the Incan empire declined.


Coca was introduced to Europe in the 16th century but only became popular in the mid 19th century, when it was developed into coca wine and pure cocaine (trust us to ruin it for everyone). Many coca containing products (such as Coca Cola) were originally sold as tonics for health and vitality, in a very similar way to energy drinks today (espresso Monster anyone?)


It was only then that everybody noticed how bad pure cocaine was for you, and the use of coca was (gradually) banned in every country outside South America, which seems a bit harsh but still.



Soporific Sponge


This was a method of inhaled anaesthetic used since the middle ages for surgery. It consisted of soaking a sponge in a mixture of plants which had properties that would make the patient lose consciousness and hallucinate for surgery, then they would shove it up their nose to keep them like that.


Before this, they would just make people faint by applying hot and cold, or applying pressure to their jugular vein (don't try this at home) which amazingly, wasn't a thoroughly effective system.


The Monte Casino Abbey's early textbooks of medicine contained the oldest written formula for a soporific sponge; opium, mandrake, hemlock and henbane were mixed with a certain amount of water, a sponge was then soaked in that, then dried in the sun. When it was time to use it, it was soaked in hot water and applied while still a bit damp. At the end of the surgery, they would use a hot vinegar soaked sponge to wake them up, which would probably work for me.


It has been suggested that the Arabs first developed soporific sponges, as the abbey translated a number of Arab texts around the same time. Also, generally a lot of Christians used alcohol as an anaesthetic for surgeries, but as Muslims were religiously instructed not to drink alcohol they had to find another way.

As well as that, manuscripts from the School of Alexandria from the same time period contain practically identical recipes for sopiforic sponges.


There were a number of different recipes as time carried on, including the use of fennel roots instead of vinegar to wake up the patient, then rubbing the vinegar on the patient's teeth instead of letting them smell it but the sponges inexplicably went out of fashion very rapidly in the 16th century. This is thought now to be down to the use of sponges in magic and the occult which put off regular people from using it, as well as the disappearance of many previously accepted medical techniques thanks to the Catholic Church banning a long list of books.


There was a brief resurgence of interest in the sponges (well, one guy) in the mid 19th century. Inhaled anaesthesia was becoming popular (such as nitrous oxide) and it drew attention to a doctor from Toulouse, Dauriol, who was using old recipes for soporific sponges to perform actual surgeries on patients, including finger amputations and tumor removals. Instead of shouting at him and rescinding his license to practice medicine, his findings were published in The Lancet, but as soon as ether was discovered the use of the sponges reduced to zero (from approximately one) almost immediately.



Mediaeval surgeon trepanning: Wellcome Collection

Trepanning


Trepanning (or trepanation) is the practice of forming a hole in the skull of a living person by drilling, scraping or cutting at the bone. It's often seen as the earliest form of surgery.

It's believed to have been used by many civilisations to relieve pain associated with neurological conditions and skull injuries (and in some cases recurrent headaches and migraines), but many anthropologists suspect that for some ancient humans it was primarily used for ritualistic purposes. (We could go into the debate of whether 'ritual’ is an overused explanation for when we simply don't understand an ancient people but that would be even more off topic than I usually am).


The earliest clear evidence of trepanning is from around 7000 years ago, and it was practiced around ancient Greece, north and south America, Africa, Polynesia and the Far East (so practically everywhere). The practice is thought to have developed independently in a few places, and then spread from there.


By the end of the Middle Ages it had been abandoned by most cultures, but it seems to have been carrying on in parts of Africa and Polynesia until the early 20th century.

The surgery had a fairly decent survival rate, considering what it is, as we can tell from skulls that have healed scars, showing they lived for many years after the surgery, and some of them have evidence of multiple surgeries.


There seems to be evidence of the use of (or at the very least the knowledge of) trepanning by Hippocrates, who writes in a section of the Hippocratic Treatsies about injuries to the head, “for a person wounded to the same extent will sustain a much greater injury, provided he has received the blow at the sutures, than if it was elsewhere. And many of these require trepanning.” Although they were definitely aware of the dangers, with Galen writing “the effect is to render the person senseless as well as incapable of all voluntary motion”.


While it was beneficial for releasing pressure on the brain in injuries and illnesses, it is theorised by some to have been used as a way to release spirits/demons that could be causing illness or pain.


The procedure is still being used today, but with anaesthetic, no rocks and a different name, for very specific types or skull injury.

Don't carve at your skull with a rock.

Please.



Tobacco Smoke Enemas


As unpleasant as it sounds, this is supposedly the origin of the phrase “blowing smoke up one's arse”.


Tobacco was brought over to Europe after being discovered being used by native peoples for medicinal purposes in The New World.


They would use it sparingly alongside other methods of treatment in healing ceremonies and also alone, but predictability the Europeans all took it a bit too far and started trying to use it for everything in very different ways. They obviously smoked it as they had been taught by the indigenous Americans, but they also got into snuff (snorted powdered tobacco) for nasal conditions, would get someone to blow tobacco smoke into their ear for pain and infection and started testing out shoving a tube up the arse and blowing some tobacco smoke up it to help with gastric complaints and hernias. Because why wouldn't you.


This was originally done with just a tube and a willing physician, but this quickly caused problems if the patient had cholera and the physician accidentally breathed in. I don’t think I need to further explain that. So then they brought in the bellows in order to pump the smoke in.


You may well be aware of this as a method for (debatably) saving people who would otherwise die of drowning, which was advocated by the The Institution for Affording Immediate Relief to Persons Apparently Dead from Drowning (snappy name) in 1774 after somewhat questionable evidence that it may well help by warming the body and stimulating the respiratory system. One of the earliest stories of success from 1746 features a woman who was pulled from the water looking quite dead. While everyone was shouting and panicking, a passing sailor offered his pipe and instructed the husband to take the pipe, shove it up her arse and “blow hard”. Amazingly, the woman woke up, and this was proof enough.


This was the era of medical experimentation, but a tobacco smoke enema for many minor conditions was advocated for in books of home remedies, and sure it seems ridiculous now, but wouldn't it have been more ridiculous if it was actually the cure for gastroenteritis and no-one had thought to try it?

(No.)


19th century resuscitation tobacco enema kit with bellows: Wellcome Images


Sources:


“A Capsule History of Pain Management” Marcia L. Meldrum, Journal of the American Medical Association Nov 2003

“Pain Relief Through the Ages” Sara Rigby, Science Focus 9th August 2017

“The Representation of Bodily Pain in Late Nineteenth-Century English Culture” Lucy Bending, Clarendon Press 1997

“The Body in Pain: The Making and Unmaking of the World” Elaine Scarry, Oxford University Press 1987

“The History of Medicine as the History of Pain” Joanna Bourke, History Today April 2011

“The Story of Pain: From Prayer to Painkillers” Joanna Bourke, Oxford University Press 2014

“Aspirin’s Four Thousand Year History” Kat Eschner, Smithsonian Magazine August 2017

“Aspirin: Turn of the Century Miracle Drug” Daniel R Goldberg, Distillations Summer 2009

“It May Come as a Shock” Amanda Schaffer. New York Times November 2006

“Ancient Medicine: Sickness and Health in Greece and Rome” Liam A Faulkner, Ichabod Press 2015

“Neuromuscular Electrostimulation Techniques: Historical Aspects and Current Possibilities in Treatment of Pain and Muscle Waisting [sic]” Heidland A, et al. Clin Nephrol 2013

“Coca: The History and Medical Significance of an Ancient Andean Tradition” Amy Sue Biondich; Jeremy David Joslin, Emergency Medicine International 2016

“Coca: A Blessing and a Curse” Ariadna Baulenas I Pubill, National Geographic History Nov/Dec 2016

“Coca Leaves First Chewed 8000 Years Ago Says Research” Jason Palmer, BBC News 2 Dec 2010

“History of the Development and Evolution of Local Anaesthesia Since the Coca Leaf” Jesús Calatayud; Ángel Gonzalez, Anaesthesiology 2003

“The Ancestors of Inhalational Anaesthesia: The Soporific Sponges (XIth-XVIIth Centuries): How a Universally Recommended Medical Technique was Abruptly Discarded” Philippe Juvin MD; Jean-Marie Desmonts MD, Anaesthesiology 2000

“Neolithic trepanation decoded- A unifying hypothesis: Has the mystery as to why primitive surgeons performed cranial surgery been solved?” Miguel A. Faria, Surgical Neurology International 2015

“Trepanation and Roman Medicine: A Comparison of Osteoarchaeological Remains, Material Culture and Written Texts” E Tullo, Royal College of Physicians of Edinburgh History 2010

“Was Hippocrates a beginner at trepanning and where did he learn?” G Martin, Journal of Clinical Neuroscience 2000

“Tobacco Smoke Enemas” Ghislaine Lawrence, The Lancet April 2002

“Special Feature: Tobacco Smoke Enemas” Sterling Haynes, British Columbia Medical Journal December 2012

“Tobacco Smoke Enemas in Eighteenth-Century Domestic Medicine” Katherine Allen, The Recipes Project February 2013

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