Analgesia and anesthesia: etymology and literary history of related Greek words.

Abstract

Greek is a particularly cultivated language and has been used to express and refine philosophical and scientific concepts for more than 30 centuries. It is not by chance that international scientific language has formed, and continues to form, many of its terms by borrowing Greek roots, words, or word parts (1). The ancient Greeks were preoccupied with what we now call the “theory of language.” Plato, in his dialogue Kratylus, examined the history of names and claimed that words, as names of things, were directly connected with the objects they indicated (2). If we learned the names of things, therefore, we could easily understand the things themselves, because the study of the language then formed the only method of scientific research and discovery (2). Today, the original meaning and use of current medical terms in ancient Greece is not widely known. In this article, the etymological, linguistic, and literary aspects of words of Greek origin, used in current anesthetic practice, are examined. The described words of Greek origin are presented in Table 1 with their Greek spelling, meaning, and etymology.Table 1: Summary of the Words of Greek Origin Presented in Alphabetical Order with Their Greek Spelling and Meaning and Their EtymologyOpium and Analgesia Opium is a Middle English word (c1100–c1500 ad) of Greek origin that passed through Latin into English (3). Opium is a diminutive of the ancient Greek opos “milky juice of plants”1 + the Latin ending -ium, equivalent to the Greek -ion (3,4) and is most probably derived from the ancestral Indo-European root *sokw-oσ,2 “juice” (1). Opium is obtained from the milky exudate of the incised unripe seed capsules of the poppy plant, Papaver somniferum, dried in the air to form a brownish gummy mass, and then further dried and powdered (5). The poppy capsules that adorn the headdress of the goddess of poppies, with five to six lozenge-shaped vertical cuttings (Figure 1), suggest that the methods of harvesting opium in the Late Bronze Age (c1500 bc) in Crete were not much different from those used today (6). Ancient Greeks called mekon “the opium poppy,” from the Indo-European root *măq(en)-, and its “milky juice”mekoneion (4,7). Homer, in the Iliad (8), was the first to use the word “mekon.” He compares the drooping head of Gorgythion, son of Priam, who was struck by a bow, with the inclining head of mekon , heavy from its seeds and the spring droplets. 3 Thucydides (c460–c400 bc) refers to themekon juice as lethal (9), whereas Nicandros 4 much later (2nd century ad) describes the side effects of mekon and presents the etymology of mekon as derived from the words me + konein “not to act” (10), denoting that opium prohibits physical action.Figure 1: The goddess of poppies (c1300–c1250 bc ) with a series of well slit poppy capsules, stained brown like opium, in her hair. Archaeological Museum of Heraklion.The names of the five main alkaloids of opium–morphine, codeine, thebaine, papaverine, and narceine–stem from ancient Greek words. Morphine, the main active ingredient of opium, was named by Sertürner in 1803 (5) after Morpheus (Moρϕε´νζ) , the mythological god of dreams, son of the god of sleep Hypnos (3), who assumed different appearances in dreams (1). Morpheus is derived from the ancient Greek morphe “form, external appearance” + the Latin ending -eus (3,4). Morphine first took the Latin name morphia or morphina, passed into English as morphine and returned into Greek in 1874. The semisynthetic derivative of morphine, heroin , stems from the Greek heroine, which is the female of hero , probably from its effects on the user’s self-esteem and the vivid hallucinations it induces (1,3,7). The word passed into Latin (heroine), from Latin into French, and then into English, from which it was returned into Greek. The word for the other natural opium alkaloid, codeine, is also of Greek origin and is derived from the word kode(ion) “poppy head” +-ine (4). Kodeion originates from the Greek word koos “cavity or objects of spherical shape” (7). In the Iliad, Homer compares the cut head ofthe Trojan Ilioneus, nailed on a spear by Peneleos, with the poppy head (8). 5 Thebaine , the word for the other phenanthrene alkaloid, is derived from the Latin word theba(ia) “ opium of Thebes of Egypt“ +-ine (3), and the word papaverine, the benzylisoquinoline alkaloid, is derived from the Latin papaver “poppy” +-ine (3), from which the Greek paparouna “poppy” originated (1). The other alkaloid, narcaine, is of Greek origin from narke “numbness” +-ine, which passed into Latin as narce (3). Toxic is another ancient Greek word, derived from toxicon “bow poison,” originally the shorter form of toxicon pharmakon and equivalent to tox(on) “bow” +-ikon and toxa, which in the plural means “arrows” (1,3). The word toxon derives from the Mycenean word to-ko-so, which may have been borrowed from the Scythic tax’sa (11), when the word did not have the meaning of poisonous. Toxon passed into Late-Latin as toxic(us) “poisonous” and then into English and French. The toxon was the main weapon of the Scythians who smeared their arrows with a pernicious poison that the ancients called scythicon or toxicon (4,11,12). It is noteworthy that, although the word pharmakon “drug,” is of uncertain origin, in the Homeric times, it meant any medicinal herb with healing properties; afterward, it also meant pharmaki(on) (ϕαρμ´ακιον) “poison” (1). The ancient Greek word analgesia is derived from the adjective analgetos “not sensing pain,” stemming from an negative + alges(is) + the ending -ia (1,3). Algesis “pain” descends from algos “somatic or psychic pain,” probably derived from the verb alego “to care, look after” (1). Today algos is used in compound medical terms such as myalgia “muscle pain,”neuralgia “pain along a nerve,”kefalalgia “headache,”osfyalgia “back pain,”ischialgia “ischiatic pain,” etc. (1). The word pain descended from the Middle English word peine (from Old French) , which is derived from the Latin word poena “penalty,” a loan from the Greek word poine “penalty” through the Indo-European root *pJOURNAL/asag/04.03/00000539-200008000-00048/ENTITY_OV0369/v/2021-01-03T074526Z/r/image-pngoin*a (1,3,4). We can assume that the suffering of pain was considered punishment for evildoing (4) or that many ancient Greeks considered diseases to be penalties sent by gods. Another Greek word for “strong psychic pain” is odyne, from which -odyn(ia) is derived. It is used in the formation of compound words, such as allodynia “pain from nonnoxious stimulation,”pododynia “neuralgia of heel and sole,”anodyne “anything that relieves or allays pain or distress,” etc. (1,3). Sleep and Anesthesia A word for the artificiallyinduced sleep, hypnosis, appeared in the Greek language in 1851, and came from English (1). It is derived from the Greek word hypnos “sleep” +-osis, from the Indo-European root *swp-nos, cognate with Old English swefn and Latin somnus (1,3,7). According to the Iliad (8) and Hesiod’s Works and Days (13), Hypnos (Sleep) and Thanatos (Death) were powerful gods, twin brothers 6 (Figure 2), sons of the goddess Nychta “night.” In ancient vase paintings, Hypnos is presented as a young man with wings who brought sleep by moving his wings or by sprinkling oblivion’s dew from a branch or even by pouring hypnotic juices from a horn. Ovidius, in the Metamorphoses (14), describes the garden of mekones, in the palace of Hypnos, from where Nychta collected nystagmous (probably meaning opium’s dew) and spread them together with darkness all over the world. 7 The word nystagmos is of uncertain origin and most probably is derived from the Greek verb nystazo “to feel sleepy,” which comes from the verbs nefstazo or nevo “to nod” (1,3) or, according to Homer, “to bend the head” (15). 8 It was much later, during the eighteenth century, that the word nystagmos acquired its current medical meaning as involuntary eyeball oscillations.Figure 2: The decoration of a red-crusted Attic crater (c515–c510 bc) presenting the twin brothers Hypnos (on the left) and Thanatos (on the right) carrying the dead Trojan hero Sarpedon to his country Lycia (Ref.8; Rhapsody XVI, verses 672 and 682). New York Metropolitan Museum of Art.The Greek word anesthesia “want of feeling,” is derived from the Greek adjective anaesthetos, and later passed as a loan word into other languages (1,3). Anaesthetos is a compound word an negative + aesthesis “without feeling, senseless” (4). The word aesthesis derives from the verb aesthanomae “to perceive through the senses,” from the ancient Greek word aesthomae “to perceive” originating from the Indo-European root *awis-dh- (1) or *αFις-θ- (7). Plato (427–347 bc), in Philebus, uses the word anesthesia with a philosophical meaning as “the oblivion of the soul from the movements (senses) of the body” (2,16). Aristotle (384–322 bc) in the definition of Ethics also describes the words anesthesia as opposite to “debauchery and prudence,” and analgesia as opposite to “anger and gentleness” (17). In his work Memory and Recollection, Aristotle differentiates faintness “weakness of the senses” from anesthesia (18). He claims that hypnos and egrigorsi “vigilance,” are both conditions of the esthetic, arising from a center located in the heart that controls movement and the senses (18). The ancient adjective esthetic means “pertaining to the senses”(aestheses) as opposed to pure intellectuality (1,3,4). During sleep, people do not sense the outside world or perceive through the senses (estheticon), which means they have anesthesia (18). The ancient Greek word koma “deep sleep, lethargy, coma” is of uncertain origin and is most probably derived from the Indo-European root *k*o[i]-mn, from which the verb keimae “to lie” was derived and then changed into koemomae “to sleep” (1,4,7). The word coma is used by Homer with the meaning of deep sleep (8,15). 9 Aristotle described very accurately “the induction of stupor by pressure on both carotids” as karosis (17). Karosis “stupor” stems from the verb karoo “to cause soporific stupor,” from which the Greek karotid(es) “carotids” is derived, because they bring the blood from the heart to kara “the head” (1,3,4,7). Hippocrates (c460–c360 bc) uses the word in connection with trauma to denote “lack of consciousness” (19), whereas the lexicographer Hesychius (2nd century bc) uses the participle carotheis to describe “the person whose head is shaken,” an accurate description of a clinical condition, concussion (8). In his pharmacological and pharmaceutical work De Materia Medica (published in 77 ad), the Greek naturalist Dioscorides was the first to use the word anesthesia in the context of surgery. He describes the hypnotic effects of a preparation in wine of mandragoras “given to those who are going to be cut or burnt (cauterized) and wish to have anesthesia” (20,21). 10 The ancient Greek word mandragoras is of uncertain origin and is probably derived either from the name of an ancient physician (7) or from the Persian name of the plant merdum gij*a “plant of man” (1). The Middle English mandrake is a variant of mandrage, short for mandragoras (3), and refers to Mandragoras officinarum containing solanaceous alkaloids. It was included as a soporific agent in pharmacopoeias and herbals until the end of the 17th century, when its male and female forms were clearly explained by Linnaeus (1707–1778). Probably, this is why O. W. Holmes suggested to W. T. G. Morton the name anesthesia for his historical discovery, referring to its use by Linnaeus as “lack of the sense of touch” (22). 11 Linnaeus also named the shrub Atropa belladona after Atropos, the oldest of the three ancient Greek Fates who cut the thread of life (3). The Latin word atropa is derived from the ancient Greek word atropos from the negative a + trope “no turning” hence “inflexible, unchangeable, implacable, deadly.” Another member of the botanical family of the Solanaceae plants is Hyoscyamos niger, popularly known as “henbane,” from which the alkaloids hyoscyamine, atropine, hyoscine, and atroscine are produced. The word hyoscyamos is a compound Greek word, derived from hyos ( genitive of hys) “hog” +kyamos “bean,” meaning “the hog bean” (3). The other historic name, Lethéon, given by Morton to ether, is derived from lethe “oblivion,” from the verb lanthano “to be latent” (1,22). Lethe also forms the first part of the compound word of Greek origin lethargy derived from leth- + the adjective argos, which originally meant “forgetful” (1,3,4). According to Greek mythology, whoever drank from the river Lethe in Hades forgot his past on the earth. Narcosis , a term until recently used as a synonym to anesthesia, is an ancient Greek word narkosis “state of unconsciousness or drowsiness produced by a drug” (1,3). It comes from the verb narkoo “to grow stiff or numb,” which is derived from the noun narke “temporary decline or loss of senses and movement, numbness,” stemming from the Indo-European root *(s)nrq-*e (1,4,7). In the VIII Rhapsody of the Iliad (8), Homer describes very accurately a traumatic injury to the brachial plexus by a jagged stone thrown by Hector, which “traumatized Teukrus above the clavicle and his hand dropped as if narcotised.”12 Hippocrates refers to the words narkae and anesthesiae as symptoms of the apoplegic patient from strangulating eileus “ileus” (23). Menon, in the synonymous dialogue of Plato, says disapprovingly of Socrates that “he narcoses (narkan) the thought of people, like the fish narke narcoses its victim“ (1,2,24). It is not until the time of Galen (138–201 bc) that the word is used in relation to drugs, and not only to trauma or fish poison. The first volatile anesthetic, diethyl ether, was given the name of aether by Froben in the 18th century (25). Aether is an ancient Greek word derived from the verb aetho “to burn,” descending from the Indo-European root *aidh- “glow” (1). Ancient Greeks presumed that aither(es) was the medium that filled the upper regions of space. The word passed as a loan through the Latin aether “upper air, pure air,” to other languages (French éther, English aether, Italian etere, etc.) (1,3). The widely used IV anesthetic thiopentone is a compound word having as a first component thio “sulfur,” derived from theion stemming from the Indo-European route *θF´εςοσ “smoke” (1). It is used in chemical nomenclature to indicate the replacement of part or all of the oxygen atoms in a compound by sulfur (3). In conclusion, the linguistic and literary aspects of the described medical terms outline the roots of analgesia and anesthesia in the ancient Greek world. The evolution of these words through the ages, either unchanged or with different meanings, and their use by modern anesthesia displays the diachronic qualities of the Greek language and culture. The best example is the word anesthesia, which had been used to mean “loss of sensation and consciousness,” many centuries before its use for a pharmacological and scientific phenomena. The writers wish to thank both Associate Professor A. Petropoulou, from the Center for Greek and Roman Antiquity of the National Hellenic Research Foundation, Athens, and the English teacher, Mrs. M. Bitsakaki, Heraklion, for reading the manuscript and making essential comments.