Although today anesthesia is taken almost for granted, its invention is a relatively recent achievement in the history of medicine. Before the 19th century, physical pain was an unavoidable component of surgery and illness, addressed with empirical solutions that were often ineffective or even dangerous. Yet, every civilization developed complex strategies over time to relieve suffering, combining botanical knowledge, pharmacological intuitions, religious rituals, and — at times — extremely brutal methods.

Origins

Since prehistoric times, humans have tried to ease pain using natural means and rituals: wounds were treated with cold water, hot ash, or medicinal plants (e.g., valerian, wild poppy). In many cultures, suffering was interpreted through a supernatural lens: priests and shamans, considered intermediaries between the visible and the invisible, took on the role of healers, while pain was viewed as divine punishment or spiritual imbalance. The first rudimentary “anesthetics” were empirical remedies (narcotic herbs, grape pomace, ice packs) or physical techniques (chest compressors or tourniquets), learned by observing animals (e.g., licking wounds) or through instinctive responses to pain. For instance, 5,000 years ago the Assyrians practiced medical strangulation by compressing the carotid arteries until unconsciousness, in order to anesthetize the patient. Similarly, tightly tying off limbs induced short-term local hypoxia, reducing sensitivity in the area.

In ancient Egypt, medicine was surprisingly advanced, blending detailed clinical practice with strong magical-religious elements. Major medical texts like the Ebers Papyrus (c. 1550 BCE) and the Edwin Smith Papyrus (c. 1600 BCE) show a deep understanding of the human body, diagnostics, and treatments. Pain, however, was not seen purely as a physical phenomenon; it was often attributed to supernatural forces, curses, or evil spirits. Treatments combined pharmacological remedies with magic spells, prayers, and exorcistic rituals. Egyptians used a variety of plant-based substances with calming effects, some of which are now pharmacologically recognized:

  • Opium (Papaver somniferum): likely introduced via Middle Eastern trade routes, used to reduce pain and induce sleep.
  • Mandrake (Mandragora officinarum): a powerful narcotic, often mixed with wine for sedative effects.
  • Myrrh, frankincense, aloe, and honey: used in ointments and compresses for their soothing, antibacterial, and healing properties.
  • Beer and wine: consumed abundantly for analgesic purposes, sometimes combined with medicinal herbs.

Ancient Greece and the Roman Empire

Greek physicians like Hippocrates (5th century BCE) and later Roman doctors like Galen (2nd century CE) began interpreting pain in more rational terms, though still lacking effective means to eliminate it. Their pharmacological remedies were similar to the Egyptians’, but more systematized:

  • Hippocrates recommended warm wine as an analgesic.
  • Galen mentioned mandrake to induce drowsiness before surgery.
  • Cold vinegar was sometimes used to reduce swelling.

In surgery, pain was addressed with brutal pragmatism: the patient was tied down, sedated with wine and mandrake, and the procedure carried out as quickly as possible. Sometimes cold (snow or ice stored underground) was applied to numb the surgical area, mostly for the wealthy.

Roman physician Celsus, in the 1st century CE, advised giving sweet wine before painful procedures and emphasized the surgeon’s stoic resolve: he “must be young, courageous, determined, and unmoved by the patient’s screams.” Until the imperial Roman age, pain relief focused on plant-based analgesics (opiates, narcotic spices, medicated wine) and techniques for localized pain suppression (cold packs or “Melfi stone” rubbed on limbs).

Geographic and Cultural Overview

In India, Sanskrit texts such as the Sushruta Samhita (ca. 6th century BCE) describe over 100 surgical instruments and many pain-relief methods, including breathing techniques, meditation, medicated wine, and cannabis.

Traditional Chinese medicine developed distinct approaches: analgesic herbs like ginseng, skullcap, and white peony, and acupuncture (dating back to at least the first millennium BCE), used to balance body energy and reduce pain.

In sub-Saharan Africa and many Amerindian tribes, pain relief mixed shamanic rituals with herbal medicine: natural painkillers and hallucinogens (khat, iboga, peyote, betel) were used in mystical rites. The Incas performed cranial trepanations with surprising survival rates; archaeological evidence suggests Inca healers applied medicinal plants and natural analgesics during surgery.

In short, pain was managed everywhere with a mix of medical, natural, superstitious, and ritual techniques: the belief that pain was intrinsic to human life prevailed until the modern era.

Christian Middle Ages and Islamic World

In the Western Middle Ages, medicine regressed: care for the body was often secondary to salvation of the soul. Pain was sometimes seen as divine punishment or a test of faith. Yet surgery continued — amputations, cauterizations, and battlefield wound treatments were carried out by barber-surgeons. Cauterization was one of the few tools available to stop acute pain or bleeding, though it was terrifying: it involved directly applying red-hot instruments to the affected area. It was used to stop hemorrhages, disinfect wounds, remove necrotic tissue, or “treat” infections. In an age without antibiotics or anesthesia, it was considered one of the few effective surgical techniques.

Some monks preserved and translated ancient — especially Arabic — texts, keeping pharmacological knowledge alive. Herbs like valerian, opium, and belladonna were still used in monasteries and convent gardens.

In the Islamic world (9th–13th centuries), medicine flourished thanks to scholars like Avicenna (Ibn Sina) and Al-Razi, who organized Greco-Roman knowledge and added their own innovations.

Avicenna’s Canon of Medicine describes the use of the spongia soporifera, a sponge soaked with opium, hashish, and mandrake, which was inhaled by the patient before surgery.

Essential oils, plant extracts, and narcotic decoctions were also used — among the clearest precursors to true anesthesia.

Renaissance and Early Modern Period

The Renaissance saw a revival of scientific and experimental interest in medicine and surgery, but cauterization remained widespread, though approached more critically. Rediscovery of classical texts and direct observation led physicians to challenge many medieval practices and promote medicine based more on observation and experience.

French surgeon Ambroise Paré (1510–1590) was pivotal in reducing cautery’s use. He famously refused to cauterize gunshot wounds with boiling oil — as was customary — opting instead for a soothing mixture of rose oil, egg yolk, and turpentine, which had far better results. Paré helped move away from brutal cauterization toward more effective, humane methods. Yet cautery remained in use throughout the 16th century, especially in war or where no alternatives existed, though it was increasingly subordinated to a patient-centered approach aimed at healing, not just burning away disease.

During this period, new analgesics arrived from exotic lands. After the discovery of the Americas, coca leaves (chewed by natives to reduce pain and fatigue) and curare (a muscle paralytic from the Amazon’s Strychnos toxifera) entered Europe. In the 16th–17th centuries, Paracelsian chemistry led to laudanum, an opium tincture in alcohol, popularized by Thomas Sydenham around 1660. Paracelsus moved beyond Aristotelian theory (fire, air, earth, water), proposing instead that all matter was composed of three principles: mercury, salt, and sulfur, and disease arose from imbalances between them.

Until this era, every surgical operation involved excruciating pain, fully experienced by the patient. The lack of effective anesthetics made surgery a brutal ordeal for both patient and practitioner. Patients were forcibly restrained, tied to the table or held by assistants, and sometimes stunned with a blow to the head or sedated with alcohol, opium, or other crude narcotics. Often, though, nothing truly numbed the pain. Surgeons were judged not on precision or hygiene — still poorly understood — but on speed: a successful amputation in under a minute was a badge of honor. The best surgeon was one who could finish the job before the patient died of shock or broke free — and who wasn’t distracted by the screams from the table. It was a medicine of courage and brutality, where survival depended more on the swiftness of the scalpel than the gentleness of care.

First Forms of Chemical and Mechanical Anesthesia

The true turning point in surgical pain management came only at the end of the 18th and beginning of the 19th century, with the realization that certain gases and vapors could induce controlled unconsciousness. In 1772, English chemist Joseph Priestley isolated nitrous oxide, or “laughing gas.” A few decades later, Humphry Davy experimented with it and noted its analgesic properties — it significantly reduced pain perception. Still, it would be a while before this discovery saw surgical use.

The real revolution came on October 16, 1846, when American dentist William T. G. Morton successfully performed the first recognized surgical anesthesia: at Massachusetts General Hospital, he had a patient inhale ethyl ether, allowing surgeon John Collins Warren to remove a neck tumor without causing pain. The event — destined to change medicine forever — was met with both enthusiasm and skepticism, but soon spread across the Western world.

Soon after, other anesthetics were introduced, including chloroform, first used in 1847 by James Young Simpson of Scotland, who tested it on himself and promoted its use in obstetrics, despite toxic risks. The range of anesthetic techniques expanded to include inhalation, injection, and later local anesthesia, laying the groundwork for modern surgery.

After millennia of surgical pain deemed inevitable — something to endure with stoicism — the arrival of ether, chloroform, and nitrous oxide marked a true scientific and cultural revolution: for the first time, people could be operated on without suffering, saving lives not just physically, but psychologically. Thanks to anesthesia, medicine took a historic leap into the future.