Anesthesia in Ancient Iran

There are many references in ancient Iranian literature on anesthesia, analgesia and pain.  Two main cultural eras are defined in Iranian culture: pre-Islamic and Islamic.

1. Anesthesia in The PreIslamic Era of Iranian Culture

• Ferdowsi (فردوسی)

The text of Shahnameh  (شاهنامه)appears to be a proof of the fact that general anesthesia had at least been described in ancient Farsi texts and possibly, that in ancient Iran general anesthesia was used in surgical procedures for the first time. . Although Shahnameh is a narrative text, according to Ferdowsi its stories are based on the actual lives of the kings. However, this section of Shâhnameh appears to be a proof of the idea that general anesthesia had at least been described in ancient Farsi texts.

• Shahre Sukh (شهر سوخته)

Shahre Sukhte (Burnt City), known as the most important city of prehistoric Iran, dating from the third millennium BC, is located in the southeast of the country. Archaeologists there have found a skull that anthropologists believe to be ‘the first evidence’ of brain surgery performance, a procedure impossible to carry out without anesthesia, from the prehistoric Iran; the skull of a 13year-old girl, diagnosed posthumously with chronic hydrocephalus.

2. Anesthesia, in the Islamic Era of Iranian Culture

• Rhazes (رازی)

He is considered the first physician to have used opium for anesthesia.

• Avicenna (ابن سینا)

The scientific citations attributed to Avicenna include the following techniques:

tracheotomy, pharyngeal intubation and a method for clearing the secretions of the upper airway in stridor and respiratory distress. He also discovered and described a number of plants having pharmacological effects, like opium; and introduced a number of methods for anesthesia induction and surgical analgesia implementation.

His recommended analgesic techniques included drug-impregnated sponges and compresses, ointments, oils, aroma therapeutic salts and drinks, smoke, pills and many more. These methods of analgesia demonstrate not only the depth of knowledge of Avicenna, but also his ability to put that knowledge into practice.  Analgesia-related references to Avicenna are numerous. He wrote of three pain-alleviating groups of drugs:

1. those that counteract and nullify pain, like fennel or linseed, used directly as a poultice on the painful region;
2. those that induce sleep and decrease activity levels, like inebriants, milk and sweet water
3. those that decrease the perception of pain, like narcotics and somniferous agents.

Avicenna also described a method for rendering a person unconscious and hence oblivious to pain, using opium, henbane and mandrake. Avicenna listed 15 different types of pain: boring, compressing, corrosive, dull, fatigue, heavy, incisive, irritant, itching, pricking, relaxing, stabbing, tearing, tension and throbbing.

References

• Dabbagh A, Rajaei S, Golzari SE. History of anesthesia and pain in old Iranian texts. Anesthesiology and pain medicine. 2014 Aug;4(3).
• Najjar J. From anesthetic sponge to nonsinking skull perforator, unitary work neurosurgery in the ancient Arabic and Islamic world. World neurosurgery. 2010 May 1;73(5):587-94.