Period Use of Laudanum

[Capt. Sterling]

Right then "Doc", what do you know of Sydenham's Laudanum? I have seen several recipes for it, but how was it dispensed,i.e, how many drops per body weight and was it mixed even further? etc... Thanks.

[Mission]

Right then "Doc", what do you know of Sydenham's Laudanum? I have seen several recipes for it, but how was it dispensed,i.e, how many drops per body weight and was it mixed even further? etc... Thanks.

I don't have Sydenham's book nor have I read it because he's a physician, not a surgeon.

To be honest I have yet to see a recipe for laudanum referred to as being Sydenham's. Most of the surgical references I have seen are in brief passing as a way to alleviate pain. In fact, the majority of medical recipes appear to me to be how much is needed to make the medicine (in a sort of Latin 17th c. dram, ounces and scruples 'percentage' kind of way) rather than how much to give the patient. Sometimes they give this info, but more often they do not. (Which is really quite curious when you think about it.)

Keep in mind the land surgeons were actually forbidden to make medicines - that was the purview of physicians and apothecaries - so sea surgeons would probably have only the minimal knowledge required in the area to do their job. On top of that, much of medicine at this time was sort of by gosh and by golly and I suspect few recipes agreed with each other so any potency they would have probably varied widely.

Still...laudanum was referred to by name and I have yet to see a recipe for it in a surgeon's manual which suggests that it would be bought ready made from an apothecary. However the recipes varied from apothecary to apothecary as they doctored them up or even substituted cheaper alternatives to make more money on the recipes.

Note the warning in John Moyle's book Chirurgius Marinus,

“In the next place be advised to see (your self) that the Medicines you put up are good...

And besides, your self is the Man whose Reputation must stand or fall, according as your Medicines operate on the Sick or Wounded, and that is another great Reason that you should look to it.

Indeed so it is, that in many Compound Medicines [laudanum being a compound medicine], a very knowing Man may be deceived, and not know if they were truly dispenced; not-

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withstanding this, if you have had any experience in Medicines, then either by the sight, smell, taste or consistence, you will perceive (within a little more or less) whether the Medicine be sound or sophisticated. But however if you go in a Merchant Man, where there is no view on your Chest, then you are happy if you have an honest Apothecary that dispences his Medicines faithfully, and that will not put bad things upon you.” (Moyle, p. 40-1)

[Capt. Sterling]

Foolish me, fer asking a surgeon...and one from a pirate ship at that. Off to read the physician's book... he does have some prescriptions/doses in it... someday you may find it of interest...thank you any way

[Mission]

Well, I looked in my notes for references to laudanum without Syndenham in them and found several with doses in them. (I found no reference to Syndenham with regard to laudanum. I stand by the statements about there probably being many concoctions of the stuff, depending on who made it.)

Most of these recipes seem to regard laudanum as an ingredient, which is why there are measures. I am going to guess that the recipes are for one dose, although I can't always be sure of that. Note that these measurements are given as weights - usually grains (g. or Gr. or gr. etc.) I don't actually own a marked grain weight, although I do know it is small. I have some unmarked weights and these might be grains. They could probably show you one at Jamestown. We might guess a grain is a drop, although that would be a guess

Moyle has all sorts of recipes for medicines with laudanum, beginning with fevers:

"Rx. Laud. Gr. Ij. (or gr. Iij. if the Patient be strong) Confect. De Hyacinth. {dram}f. Alkerm. {scruple}j. misce. f. Bol.

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Sometimes I have give the Laudinum in a {dram}j. of Diascordium.

And sometimes per se.; but which way so ever you give it, it is the most excellent of all Medicines in this case [some sort of fever]." (John Moyle, p. 164-65)

"And as to the Fever that attends this disease [Ague - fever brought on most likely from Malaria), you must (to asswage heat and thirst) do as I taught in Fevers.

But if all that I have said will not prevail, then you must betake your self to this approved means following (due preparation having first preceded).

Rx. Laud. {grain} iij, dissolve it in a spoonful of Spir. Vini.

And let the Patient take it about an hour before the Fit is to come..." (Moyle, p. 198)

Dental work:

"And if it be a hot Rheume, take only Laudinum, {grain}ij. dissolve it in a Spoonful of Sack, and dip a small pellet of Lint in it, and put it into the hollow Tooth..." (Moyle, p. 242-3)

Colic:

"Or, if Clysters have first preceded and wrought, you may give the Patient, in the greatest extremity, Laud. {grain}iij. or iv. either in a Pill, or dissolved in a little Spirit of Mint, and there will ease follow incontinently, only keep the Patient warm whilst it works its effects." (Moyle, p. 202)

Arthritis:

"Rx. Laud. {grain} iij. f. Pil. give it the Patient, and expose him to rest, covering him very warm." (Moyle, p. 214)

and Nose bleeds:

"These things being done and over, you may give Laudinum {grain}iij. and expose the Patient to rest...

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"Then I put him to Bed, and gave him Laud. Liquid. Gutt. 40 in a Glass of Beer: This Composed the Ebulition of he Spirits and Blood, and Completed the Cure." (Moyle, p. 241-3)

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John Woodall gives his own recipe for Laudinum Paracelsi [all in Latin, of course]in his book, the surgions mate. [Note - Woodall's death precedes Sydenham's first book by almost 25 years.]:

Rx. Opii Thebaici uncias i[...]es.

Succi Hyoscyami debito tempore collecti, & in Sole prius inspissati unciam unam & sem specierum Diambræ & Diamosschi, fideliter dispensatarum ana uncias duaes cum dimidio mummiæ transmarinae & selectæ unciam sem.

Salis perlarum.

Gorallorum ana drachm. iij.

Liquoris Succini Albi per Alcohol Vini extracti.

Ossis de corde Cervi ana drachmam j.

Lapidis Bezoartici.

Unicorni animalis vel mineralis drachmam unam.

Moschi.

Ambrae ana scrupulum J.

In defectu genuini auri potabilis nullis corrosivis inquinati addantur,

Oleorum Anisi.

Carui.

Arantiorum.

Citrorum.

Nutistæ.

Cariophyllorum.

Cinamomi.

Succini ana guttæ 12.

Fiat ex his secundum artem Chymicam, massa, sen extractum, ex que a[...] necessarios usus, possint pillulae efformari." (Woodall, p. 229)

And he advises a general dose:

"The dose of this opiat medicine, is two, or three, or foure graines, if there be loosenesse of the belly,

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as is rehearsed, it worketh much the better. Note that in some parts of the world this medicine is mentioned dose will doe no ease, wherefore when you finde that by experience, in the next patient give more, but not to the same patient without great reason. It is best given in any occasion accompanied with waters or other medicines, which are most appropriate to the diseases and parts diseased, and yet may very well bee given alone in a pill, which I willingly do, for that the patient then is least troubled with the taste thereof.

But beware you use not this medicine to any, which are feeble through a great cough being oppressed with tough phleagme and shortnes of breath, for there is not good: if the disease be violent, as I have sayd, one dose may bee given after another, with sixe houres at the least distance, very safely, but Ozwaldus Crollius saith, within foure howers, as is said in the cure of Distentery." (Woodall, p. 227-8)

He also advises a specific dose for a case of the flux [dysentery or diarrhea]:

"...if he cannot take his rest, give him three graines of Laudanum in a pill, and so appoint him to rest..." (Woodall, p. 203)

He goes on advise for severe cases of flux:

"...thou mayst returne to Laudanum againe and againe, alwayes remembring, as is sayd, there be foure houres at the least distance, betwixt each dose..." (Woodall, p. 209)

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And here's a dose that's about four times what anyone else suggests from John Atkins' book The Navy Surgeon:

"Example of a Fractured Thigh

I. In the Hard Winter, 1709, a Young Man of twenty Years of Age fractured his Thigh, by a Surging of the Cable, about four Fingers Breadth above the Knee. I reduced it, and proceeded in the Method before laid down; only instead of Junks, I infixed the Dressings with a Sheet of Pasteboard, (that came from above the Fracture to below the Calf,) placed the Leg and Thigh even, and in a Position easy to him, kept the Great Toe in a Line with his Knee, and carefully filled up the Vacuities at the Ancle and Ham with Compresses: I also bled him; and in the Evening gave the following composing Draught.

Rx. Aq. Theriac. Syr. de Mecon. a {ounce}s. Laud. Liq. g.[rains] xvj Aq. Hord. {ounce}ij. F. Haust. (Atkins, Navy Surgeon, p. 59)

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Aaron Smith mentions it and an attempted overdose quantity in an account where he was captured by pirates, although this is about 100 years past period:

"I begged that the medicine chest might be placed near me, which they did, & I seized that opportunity of swallowing the contents of a small vial of laudanum, about a hundred and thirty drops, hoping that I should wake no more in this world."

...

I now began to feel the soporiferous effects of the laudanum, and, laying myself down upon my mattress, commended my soul into the hands of the God who gave it, beseeching him to forgive me for the act I had committed, and resigned myself, as I thought in the arms of death. I soon fell into a profound sleep, which lasted the whole night, and in the morning they found such difficulty to arouse me, that they imagined I had poisoned myself and was dead.

The captain accused me of having done so, and threatened me with a second torturing if I ever made another attempt. I told him I had merely taken some opiate medicine to render me insensible to the pain I suffered, and that I had taken an usually powerful effect upon me. He then asked me if I could attend to the sick? I said that I would endeavor to do so; but, upon attempting to rise, I found my strength fail, and my limbs so stiff and in such a state, that I began to think that I had lost their use. A mattress was however placed under me to help me sit up, & the medicine chest placed by my side; and in this manner, although it put me to excruciating agony,. I began to perform my task.” (Smith, p. 41-4)

[Mission]

So I decided to read Sydenham's book (The Whole Works of That Excellent Physician Dr. Thomas Sydenham) and I found some recipes related to narcotics, which are quite clearly stated; much more so than most surgical manuals. But they do not give a recipe for Laudanum itself; he appears to recommend a purchased version. (Thinking on this, it makes sense. Most physicians wrote prescriptions to be prepared by apothecaries.) However, he does give a dosage:

"The Narcoticks, which I frequently give, are either London Laudanum, from one Grain to one Grain and a half, or the following:

Take of Cowslip flowers one handful, boil them in a sufficient quantity of Blackberry water, dissolve half an Ounce of Diacordium, and half a Spoonful of the Juice

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of Lemons, in three Ounces of strained Liquor; mingle them. Or,

Take of Blackberry water one Ounce and a half, Epidemick water two Drams, Liquid Laudanum sixteen Drops, Syrup of Gilliflowers one Dram; mingle them." (Sydenham, p. 28-9)

[Mission]

Here is a recipe for liquid laudanum from Sydenham's book. This is indicated for use in the Bloody Flux and he suggests several doses based on the particular symptoms as well as the particular patient - particularly in regard to their age, constitution and humoral type. These are scattered throughout several pages of his text, which I have not entered into my notes, so you'll have to make do with the preparation which I am typing in directly for your reference here. As I recall, it was between 10 ounces for children and 30 something ounces for some adults. (I still amazed at the clarity of his recipes. Why didn't the surgeons follow his lead in their books?)

"The liquid Laudanum, which, as I said, I used daily, was prepar'd according to the following plain manner:

Take of Spanish Wine, one Pint; of Opium, two Ounces; of Opium, two Ounces; of Saffron one Ounce; of the Powder of Cinnamon and Cloves, each one Dram: let them be infus'd together in a Bath two or three Days, till the Liquor comes to a due Consistence; strain it, and keep it for use.

I do not think this Preparation has more Virtue than the solid Laudanum of the Shops; but I prefer it before that for its more commodious Form, and by reason of the greater Certainty of the Dose; for it may be drop'd into Wine, or into any distill'd Water, or into any other Liquour. [Note that 'liquor' here seems to have a much broader definition than what we think of today and can even include non-alcoholic beverages.] And truly I cannot here forbear mentioning, with Gratitude, that Omnipotent G O D, the Giver of all good Things, has not provided any other Remedy for the Relief of reached Man, which is so able either to quell more Diseases, or more effectually to extirpate them, than opiate Medicines taken from some Species of Poppies. And tho there are some that would fain perswade credulous People, that almost all the Virtues of opiate Medicines, especially of Opium, principally depend on their artificial Preparation of it; yet he that shall make Experience the Judge, and shall as often try the simple Juice, as it comes by Nature, as the Preparations of it, if he be careful in his Observation, will scarce find any difference; he will certainly know, that those admirable Effects which it produces, proceed from the native Goodness and Excellency of the Plant, and not from the Skill of the Artificer. And so necessary is this Instrument in the hand of a skilful Man, that without it Physick would be very lame and imperfect; and he that rightly understands it, will do greater things than can be well hop'd for from one

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Medicine: For surely he is very unskilful, and little understands the Virtue of this Medicine, who only knows how to use it to promote Sleep, to ease Pain, and to stop a Looseness [Diarrhea]; whereas it may be accomodated, like the Delphick Sword, to many other uses: and it really a most excellent Cordial Remedy, I had almost said the only one, which has been hitherto found amongst the Things of Nature." (Sydenham, p. 123-4)

[Mission]

Sydenham has much to say about medicines particularly Laudanum, so I decided to split this topic out of the one it was in because I keep coming across interesting quotes on the subject.

"For instance, being call'd to a certain Patient, that was almost destroy'd with this dreadful Symptom... and with violent Vomiting, and just dying by reason of the violence of the Convulsions; he was in a cold Sweat, and his Pulse could scarce be felt: I gave him twenty five Drops of my liquid Laudanum in one Spoonful of strong Cinnamon-water; for I did not dare to give a larger Vehicle, lest it should occasion Vomiting (as it often happens when there is a great inclination to Vomiting) and sitting by the Bed about half an Hour, and perceiving the strength of the Medicine was not sufficient to stop the Vomiting, nor the Convulsions, I was forced to repeat it, and to increase the Dose so (but there was such a space as that I might know what was to be hoped for, from what was already taken before I gave any more) as that the violence of Symptoms was at length quell'd; but yet they were apt upon the least Motion to rebel, and therefore I strictly order'd that the Body should be kept very quiet for a few days, and that he should taken now and then the aforesaid Medicine in smaller dose, when he was well, to confirm the business; and this succeeded according to my desire.

Nor is there any reason why any one should count me too bold, because I venture to give so great a quantity of liquid Laudanum; for it is plain by Experience, that for those Diseases Preparations of Opium are indicated (and they are three, violent Pain, Vomiting, or a great Looseness, and great Disorders of the Spirits) in these both the Dose of the Remedy, and the Repetition of it, must be according to the greatness of the Symptom: for that dose which will be sufficient to quell a small Symptom, will be overcome by a stronger; and that which would otherwise endanger the Life of the Patient, will in such a case save his Life." (Sydenham, p. 220)

I think it's particularly interesting that among "those Diseases [where] Preparations of Opium are indicated" he includes "great Disorders of the Spirits." Laudanum - the predecessor to Zoloft? Keep in mind that he is a physician not a surgeon. Physicians were not usually on ships, except for higher 'rate' British Royal Navy ships like first- and maybe second- and/or third-rate ships. (Don't quote me on that. I read it somewhere, but it's not really relevant to my research so it's not in my notes.)

[Mission]

Here's some interesting stuff from Sydenham on dosage. He's actually talking about treating the Confluent Small-Pox, although he says things in general on Laudanum dosage that would apply elsewhere. I'm going to insert some paragraph breaks to make it a bit more readable; this is actually one long dense paragraph.

"Now to speak of the Sorts of Anodynes, tho' I have used Liquid Laudanum for many Years with good Success, when this Indication was to be answered, yet I think Diacodium [syrup of poppies - according to my pharmacopoeia, this contains about one grain of opium per ounce] is to be preferred before it: tho' both may be used for the same Purpose, yet I suppose the Laudanum heats a little more than the Syrup. [He's referring to the heating property of medicines as it relates to patient's humors. Medicines were thought to have heating/cooling/wet/dry properties that related to and interacted with the bodily humors and the type of disease.]

As to the Dose, that is not only to be suited to the Age of the Patient, but to the Degree of the Symptoms; and that which perchance would be too much for a Person whose Spirits are well composed, would not be sufficient for another, who has his Spirits enraged: for Instance, we suppose in general that six Drams are sufficient for most; but for those that have the Small-Pox, when this kind of Remedy is indicated, we must scarce give less than an Ounce, if we will do any Thing to the Purpose; which Quantity indeed must be prescribed for one Dose through the whole of this Disease.

I speak now of grown People; for if it be given to Children, the Dose must be lessened according to their Age. And truly Anodynes are not so much indicated in Children that have the Small-Pox, as in grown People, for they are more prone to sleep the whole Time of the Disease; yet if they are in much Danger, I should be afraid to abstain from Opiates.

But as I was about to say, it is very hard to determine the Dose of the Anodyne in all the cases in which they are indicated; for whether it be in any inordinate Motion of the Spirits, or in violent Vomiting, or Fluxes of the Belly [diarrhea], or great Pains; in which three Disease Anodynes are chiefly indicated (as we said in another Place) they are to be given in such a Manner, that if the first Dose does not do the Business, another, and also another, is to be given at due Times, till at length the Medicines answer the Intention of the Physician; not so much regarding the Quantity taken, as the Effect it should produce in the Patient: And when this is done, and not before, we must desist from so frequent and great Use of the Anodyne; but such a Space must be interposed between the Doses, that we may

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be able to know whether the last performed the Business designed, before another be prescribed. But when we have once obtained our End, the Dose of the Anodyne is to be lessened in the Progress of the disease, as Things appear." (Sydenham, p. 286-7)

[Daniel]

Interesting. What does he say about the prognosis of confluent smallpox? Wikipedia mentions a set of confluent victims of whom 62% died; I wonder if that was typical.

Also, do you know anything about laudanum addiction and abuse in GAoP? All the instances I've heard of are from the 19th century.

[Mission]

Oh, gosh. It goes on for 30 pages in my edition and it didn't interest me enough to highlight anything other than that bit. I recently discovered this book on-line here, although it is a much later edition than the one I am reading. In that edition, the confluent small pox discussion starts on page 245 if you want to read through it.

He doesn't usually list a prognosis per se, instead he lists the symptoms, things he tried to cure it, noting what worked and sometimes what didn't. He occasionally brings up a case study although not as often as other medical authors. Like most period authors he usually goes off on tangents about any unusual symptoms that occurred in conjunction with the disease he is discussing, what he tried to cure them, what worked, etc. I do remember him railing against the use of 'hot' treatments pretty strongly, singling out nurses and non-physicians for prescribing such.

I don't recall anything about Laudanum addiction from the period books I've read. Other than Sydenham, most of the authors I've read refer to it in passing as a treatment, sometimes noting its effectiveness. Of course, my focus has been on surgeons who would not have gotten as deeply into medicines as a physician or apothecary would have.

[Mission]

Here's something fun to read for ya' regarding Laudanum and dosages

"...for I have found by Experience, that a Dysentery is most certainly and most speedily cures, if without any more ado, the Flux be presently stopt by Laudanum; for this Disease is so very violent and fierce, that if you go on in purging when the Dysentery is confirmed, there is great danger, lest it being heightened by this means, should by reason of its incredible Ferment, torment the Patient longer, do afterwards what you can, or perhaps kill him. Therefore being called, I presently gave him about twenty two Drops of liquid Laudanum, in Epidemick Water, or in Aqua Mirabilis, or the like, to be repeated twice in the space of twenty four Hours or oftner at set times, if the Dose prescribed to be used only Morning and Evening, be not sufficient to quell the Gripes and the Bloody Stools. The Excrement being a little thickened, or of a better Consistence (which is the first sign of Recovery) and the Symptoms being vanquished, I suppose it is safest for the Patient to continue for some time in the use of the aforesaid Medicine, Morning and Evening, taking some Drops daily, till there be no farther occasion. But is is to be observed, that I order the Sick to keep his Bed longer after the use of the Anodyne [referring to the Laudanum]; for any erect Posture soon disturbs the Head, unless the Patient sleep long enough after it." (Sydenham, p. 422)

That is a lot of freaking Laudanum. No wonder people got hooked.

[Commodore Swab]

A dram is easy enough to measure as it is a common measurement for black powder, one of my flasks is marked in drams and is adjustable from 2.25 to 3.5 if memory serves.

[Mission]

Silkie McDonough sent me some questions about Laudanum that I thought would be a good thing to answer here. (If you guys want private consultations, you have to pay the surgeon. )

>How was it obtained?

It would be obtained from an apothecary. Laudanum is a mixture of substances as you will note from earlier posts in this thread. I don't know the process an apothecary would have gone through to get the opium (or, as I have seen it written in some books 'opheum'), but it seems to have mostly come from the East Indies along with a lot of the other drugs and spices during this period.

>What was it used for most often? Pain or sleep or both?

I have seen it recommended once or twice for encouraging sleep, but primarily in cases where the patients were in pain. So I would say opiates were used mainly as they are now: to alleviate pain.

>How was it perscribed? Was it from a physician or an apocathary. I am not looking for a dissertation just generalities.

On land, physicians prescribed it and apothecaries would have filled it. At least that's how it was supposed to go...

Here's the dissertation. (The real answer to this question is not straightforward. Plus I like giving dissertations. You know that.)

All of the surgical manuals I have from period contain recipes for drug mixtures, including one or two that give receipts for laudanum. So, despite the fact that surgeons weren't technically allowed to prescribe drugs, they obviously made them and administered them. On ships there really wasn't anyone else to do this, so they were given a chest of medicines and allowed to practice that bit of medicine.

See, physicians didn't usually practice at sea. Some of the large BRN ships had a physician position, but a merchant ship (the favored target of pirates) rarely would. (They were too expensive to hire and mostly not needed.) Well... there is physician/privateer Thomas Dover...but he was considered a bit loony. He claims to have taken Mercury every day as a preventative, so that may have had something to do with it.

In addition there appear to have been more than a few cases of Apothecaries prescribing drugs without Physician's scripts (although I can't point to any specific cases involving Laudanum or anything. I generally don't read physician or apothecary books unless they are directly related to the sea.) The Physicians complained about this to the Worshipful Society of Apothecaries of London and a lot of finger-pointing seems to have been the result with little real progress from my limited understanding. (So it's really not any different than any other attempt to strictly divide labor throughout history.)