Laudanum  

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The Birth of Venus (detail), a 1486 painting by Sandro Botticelli
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The Birth of Venus (detail), a 1486 painting by Sandro Botticelli

Laudanum is an alcoholic tincture of opium. Laudanum is also known as tincture of opium, opium tincture, or tinctura opii. There are several varieties of opium tinctures, including wine of opium (vinum opii or Sydenham's Laudanum), which contains sugar, white wine, cinnamon, and cloves; saffronized tincture of opium, also known as tinctura opii crocata, containing saffron; deodorized tincture of opium (discussed below); and camphorated tincture of opium (tinctura opii camphorata or paregoric), containing camphor. Each variety of opium tincture, including laudanum, contains a different amount of opium and inactive ingredients. The term "Laudanum" should be applied only to a specific tincture of opium containing approximately 10 milligrams of morphine per milliliter.

Contents

History

Paracelsus, born Phillippus Aureolus Theophrastus Bombastus von Hohenheim (1493–1541) in Salzburg, Austria, a 16th century Swiss-German alchemist, discovered that the alkaloids in opium are far more soluble in alcohol than water. Having experimented with various opium concoctions, Paracelsus came across a specific tincture of opium that was of considerable use in reducing pain. He called this preparation laudanum, derived from the Latin verb laudare, to praise. Initially, the term "laudanum" referred to any combination of opium and alcohol. Indeed, Paracelsus' laudanum was strikingly different from the standard laudanum of the 17th century and beyond. His preparation contained opium, crushed pearls, musk, amber, and other substances. One researcher has documented that "Laudanum, as listed in the London Pharmacoepoeia (1618), was a pill made from opium, saffron, castor, ambergris, musk and nutmeg."

Laudanum remained largely unknown until the 1660s when an English physician named Thomas Sydenham (1624–1689) compounded a proprietary opium tincture that he also named laudanum, although it differed substantially from the laudanum of Paracelsus. In 1676 Sydenham published a seminal work, Medical Observations Concerning the History and Cure of Acute Diseases, in which he promoted his brand of opium tincture, and advocated its use for a range of medical conditions. By the 18th century, the medicinal properties of opium and laudanum were well-known. Several physicians, including John Jones, John Brown, and George Young, the latter of whom published a comprehensive medical text entitled Treatise on Opium extolled the virtues of laudanum and recommended the drug for practically every ailment. "Opium, and after 1820, morphine, was mixed with everything imaginable: mercury, hashish, cayenne pepper, ether, chloroform, belladonna, whiskey, wine and brandy."

As one researcher has noted: "To understand the popularity of a medicine that eased--even if only temporarily--coughing, diarrhoea and pain, one only has to consider the living conditions at the time." In the 1850s, "cholera and dysentery regularly ripped through communities, its victims often dying from debilitating diarrhoea," and dropsy, consumption, ague and rheumatism were all too common.

By the 19th century, laudanum was used in many patent medicines to "relieve pain... to produce sleep... to allay irritation... to check excessive secretions... to support the system... [and] as a soporific". The limited pharmacopoeia of the day meant that opium derivatives were among the most efficacious of available treatments, so laudanum was widely prescribed for ailments from colds to meningitis to cardiac diseases, in both adults and children. Laudanum was used during the yellow fever epidemic. Innumerable Victorian women were prescribed the drug for relief of menstrual cramps and vague aches. Nurses also spoon-fed laudanum to infants. The Romantic and Victorian eras were marked by the widespread use of laudanum in Europe and the United States. Mary Todd Lincoln, for example, the wife of President Abraham Lincoln, was a laudanum addict, as was the English poet Samuel Taylor Coleridge, who was famously interrupted in the middle of an opium-induced writing session of Kubla Khan by a "person from Porlock." Initially a working class drug, laudanum was cheaper than a bottle of gin or wine, because it was treated as a medication for legal purposes and not taxed as an alcoholic beverage.

Laudanum was used in home remedies and prescriptions, as well as a single medication. For example, a 1901 medical book published for home health use gave the following two "Simple Remedy Formulas" for DYSENTERRY [sic]: (1) Thin boiled starch, 2 ounces; Laudanum, 20 drops; "Use as an injection every six to twelve hours"; (2) Tincture rhubarb, 1 ounce; Laudanum 4 drachms; "Dose: One teaspoonful every three hours." In a section entitled "Professional Prescriptions" is a formula for DIARRHOEA (ACUTE): Tincture opium, deodorized, 15 drops; Subnitrate of bismuth, 2 drachms; Simple syrup, 1/2 ounce; Chalk mixture, 1½ ounces, "A teaspoonful every two or three hours to a child one year old." DIARRHOEA (CHRONIC): Aqueous extract of ergot, 20 grains; Extract of nux vomica, 5 grains; Extract of Opium, 10 grains, "Make 20 pills. Take one pill every three or four hours."

The early 20th century brought increased regulation of all manner of narcotics, including laudanum, as the addictive properties of opium became more widely understood, and "patent medicines came under fire largely because of their mysterious compositions." (In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines," by Barbara Hodgson) In the United States, the Pure Food and Drug Act of 1906 required that certain specified drugs, including alcohol, cocaine, heroin, morphine, and cannabis, be accurately labeled with contents and dosage. Previously many drugs had been sold as patent medicines with secret ingredients or misleading labels. Cocaine, heroin, cannabis, and other such drugs continued to be legally available without prescription as long as they were labeled. It is estimated that sale of patent medicines containing opiates decreased by 33% after labeling was mandated. In 1906 in Britain and in 1908 in Canada "laws requiring disclosure of ingredients and limitation of narcotic content were instituted." (ibid)

The Harrison Narcotics Tax Act of 1914 restricted the manufacture and distribution of opiates, including laudanum, and coca derivatives in the United States; this was followed by France's Loi des stupefiants in 1916, and Britain's Dangerous Drugs Act in 1920.

Laudanum was supplied to druggists and physicians in regular and concentrated versions. For example, in 1915, Frank S. Betz Co., a medical supply company in Hammond, Indiana, advertised Tincture of Opium, U.S.P., for $2.90 per lb., Tincture of Opium Camphorated, U.S.P, for 85 cents per lb., and Tincture of Opium Deodorized, for $2.85 per lb. Four versions of opium as a fluid extract were also offered: (1) Opium, Concentrated (assayed) "For making Tincture Opii (Laudanum) U.S.P. Four times the strength of the regular U.S.P." tincture, for $9.35 per pint; (2) Opium, Camphorated Conc. "1 oz. making 8 ozs. Tr. Opii Camphorated U.S.P (Paregoric)" for $2.00 per pint; (3) Opium, Concentrated (Deodorized and Denarcotized) "Four times the strength of tincture, Used when Tinct. Opii U.S.P. is contraindicated" for $9.50 per pint, and (4) Opium (Aqueous), U.S.P., 1890, "Tr. (assayed) Papayer Somniferum" for $2.25 per pint.

In 1929-30, Parke, Davis & Co., a major United States drug manufacturer based in Detroit, Michigan, sold "Opium, U.S.P. (Laudanum)" as Tincture No. 23 for $10.80 per pint (16 fluid ounces), and "Opium Camphorated, U.S.P. (Paregoric)" as Tincture No. 20, for $2.20 per pint. Concentrated versions were available. "Opium Camphorated, for U.S.P. Tincture: Liquid No. 338" was "exactly 8 times the strength of Tincture Opium Camphorated (Paregoric) [italics in original], U.S.P., "designed for preparing the tincture by direct dilution," and cost $7 per pint. Similarly, at a cost of $36 per pint, "Opium Concentrated, for U.S.P. Tincture: Liquid No. 336," was "four times the strength of the official tincture," and "designed for the extemporaneous preparation of the tincture." The catalog also noted: "For quarter-pint bottles add 80c. per pint to the price given for pints."

Toward the middle 20th century, the use of opiates was generally limited to the treatment of pain, and opium was no longer a medically-accepted "cure-all". Further, the pharmaceutical industry began synthesizing various opioids, such as propoxyphene, oxymorphone and oxycodone. These synthetic opioids, along with codeine and morphine were preferable to laudanum since a single opioid could be prescribed for different types of pain rather than the "cocktail" of laudanum, which contains nearly all of the opium alkaloids. Consequently, laudanum became mostly obsolete as an analgesic, since its principal ingredient is morphine, which can be prescribed by itself to treat pain. There is no medical evidence that laudanum is superior to treating pain over morphine alone.

In 1970, the U.S. adopted the Uniform Controlled Substances Act, which regulated opium tincture (Laudanum) as a Schedule II substance (currently DEA #9630), placing even tighter controls on the drug.

By the late 20th century, laudanum's use was almost exclusively confined to treating severe diarrhea. The current prescribing information for laudanum in the U.S. states that opium tincture's sole indication is as an antidiarrheal, although the drug is occasionally prescribed off-label for treating pain and neonatal withdrawal syndrome.

Depictions in fiction

Literature

Film

Television

  • In the Hornblower television movies "The Mutiny" and "Retribution", Dr. Clive (played by David Rintoul) freely dispensed laudanum to injured or beaten seamen, to the mentally unstable Captain Sawyer (played by David Warner), and to himself.
  • In an episode of the Little House on the Prairie television series titled "Blizzard", several children are experiencing pain in their hands and feet as they are warmed up in the schoolhouse after suffering from partial hypothermia and frostbite. To help them with the pain, Dr. Baker issues laudanum, but "just half a teaspoon!".
  • In episode seven of the first season of Bramwell, Lady Cora Peters (played by actress Michele Dotrice) suffered acute stomach pains which turned out to be appendicitis inaccurately diagnosed as tifilitis by her doctor who prescribed a small bottle of laudanum to ease her pain.
  • In many episodes of the series"Gunsmoke," Doc Adams gives laudanum to his patients.





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