Editing Laudanum (section)

== History ==
===Paracelsus's laudanum===
[[Paracelsus]], a 16th-century [[German-speaking Swiss|Swiss]] [[alchemist]], experimented with various [[opium]] concoctions, and recommended opium for reducing pain. One of his preparations, a pill which he extolled as his "archanum" or "laudanum", may have contained opium.<ref name="Sigerist">{{cite journal | vauthors = Sigerist HE |title=Laudanum in the Works of Paracelsus |journal=Bull. Hist. Med. |date=1941 |volume=9 |pages=530–544 |url=http://www.samorini.it/doc1/alt_aut/sz/sigerist-laudanum-in-the-work-of-paracelsus.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.samorini.it/doc1/alt_aut/sz/sigerist-laudanum-in-the-work-of-paracelsus.pdf |archive-date=2022-10-09 |url-status=live |access-date=5 September 2018}}</ref> Paracelsus's laudanum was strikingly different from the standard laudanum of the 17th century and beyond, containing crushed [[pearls]], [[musk]], [[amber]], and other substances.<ref name=Davenport-Hines>{{cite book | vauthors = Davenport-Hines R | author-link1 = Richard Davenport-Hines
 | title = The Pursuit of Oblivion | year = 2004 | url = https://books.google.com/books?id=dFRd2MMrtiUC&q=laudanum+history+paracelsus&pg=PA31
 | access-date = 2009-01-16 | chapter = Early History | publisher = Norton
 | chapter-url = https://books.google.com/books?id=dFRd2MMrtiUC&q=laudanum+history+paracelsus&pg=PA31 | ref = Davenport-Hines | isbn = 9780393325454 }}</ref>

=== British laudanum ===
One researcher has documented that "Laudanum, as listed in the ''London Pharmacopoeia'' (1618), was a pill made from opium, saffron, castor, [[ambergris]], musk and nutmeg".<ref name = "Hodgson_2001">{{cite book | title = In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines | vauthors = Hodgson, Barbara | location = Buffalo, New York, USA | publisher = Firefly Books | date = 2001 }}</ref>{{rp|45}}

=== Sydenham's laudanum ===
In the 1660s [[England|English]] physician [[Thomas Sydenham]] (1624–1689) popularized 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.<ref name="Davenport-Hines"/>

=== 18th century ===
By the 18th century, the medicinal properties of opium and laudanum were well known, and the term "laudanum" came to refer to any combination of opium and alcohol.

In the 18th century several physicians published works about it, including [[John Jones (physician)|John Jones]], who wrote ''The Mysteries of Opium Revealed'' (1700), which was described by one commentator as "extraordinary and perfectly unintelligible".<ref>{{Cite DWB|title=JONES, JOHN (1645 - 1709), cleric |id=s-JONE-JOH-1645|access-date=2021-07-10}}</ref><ref>{{Cite book| vauthors = Hardy EG |url=https://archive.org/details/jesuscollege08hard|title=Jesus college|date=1899| location  =London | publisher = F.E. Robinson and co. |others=PIMS - University of Toronto}}</ref> The Scottish physician [[John Brown (physician, born 1735)|John Brown]], creator of the Brunonian system of medicine, recommended opium for what he termed asthenic conditions, but his system was discredited by the time of his death.<ref>{{Cite journal| vauthors = Lawrence C |date=1988|title=Cullen, Brown and the poverty of essentialism|journal=Medical History. Supplement|issue=8|pages=1–21|issn=0950-5571|pmc=2557347}}</ref><ref>{{Cite book| vauthors = Risse GB |title=New Medical Challenges during the Scottish Enlightenment|chapter-url=https://brill.com/view/book/9789004333000/B9789004333000-s007.xml|chapter=The Royal Medical Society versus Campbell Denovan: Brunonianism, the Press, and the Medical Establishment|date= January 2005 |pages=105–132|publisher=Brill|isbn=978-90-04-33300-0|language=en|doi=10.1163/9789004333000_007}}</ref> The most influential work was by [[George Young (surgeon, born 1692)|George Young]], who published a comprehensive medical text entitled ''Treatise on Opium (1753).''<ref>Young G. ''A treatise on opium, founded upon practical observations''. London: printed for A.Millar; 1753</ref> Young, an Edinburgh surgeon and physician, wrote this to counter an essay on opium by his contemporary [[Charles Alston (botanist)|Charles Alston]], professor of botany and materia medica at Edinburgh who had recommended the use of opium for a wide variety of conditions. Young countered this by emphasising the risks ''<nowiki/>'...that I may prevent such mischief as I can, I here give it as my sincere opinion... that opium is a poison by which great numbers are daily destroyed.''' Young gives a comprehensive account of the indications for the drug including its complications. He is critical about writers whose knowledge of the drug is based on chemical or animal experiments rather than clinical practice. The treatise is a detailed, balanced and valuable guide to prevailing knowledge and practice.<ref name="Davenport-Hines" /><ref>{{Cite journal|last=Macintyre|first=IM|date=2012|title=A Sceptic and an Empiric in Medicine: George Young (1692-1757) and the beginnings of the Scottish medical Enlightenment|journal=Journal of the Royal College of Physicians of Edinburgh|volume=42|issue=4|pages=352–360|doi=10.4997/JRCPE.2012.415|issn=2042-8189|pmid=23240124|doi-access=free}}</ref> As it gained popularity, opium, and after 1820, morphine, was mixed with a wide variety of agents, drugs and chemicals including mercury, hashish, cayenne pepper, ether, chloroform, belladonna, whiskey, wine and brandy."<ref name="Hodgson_2001" />{{rp|104}}

[[File:Whalley "Confessions of a laudanum drinker", 1866 Wellcome L0016409.jpg|thumb|''Confessions of a laudanum drinker'', [[The Lancet]], 1866]]During the late 18th and early 19th centuries, patients undergoing surgery were often administered laudanum and alcohol, and had their hands restrained and bodies held down while the operation was performed.<ref>{{Cite book | vauthors = Adkins L, Adkins R |url=https://books.google.com/books?id=8UIURafSXQgC |title=Eavesdropping on Jane Austen's England: How our ancestors lived two centuries ago  |publisher=Little, Brown Book Group |year=2013 |isbn=978-1-4055-1364-7 |location=London |pages=312 |language=en}}</ref>

=== 19th century ===
By the 19th century, laudanum was used in many [[patent medicine]]s to "relieve [[pain]] ... to produce [[sleep]] ... to allay irritation ... to check excessive secretions ... to support the system ... [and] as a [[soporific]]".<ref name=Potter>{{cite book |last = Potter| first = SO | title = A Compend of materia medica, therapeutics, and prescription writing... | publisher = P. Blakiston, Son & Company | year = 1902 | url = http://www.henriettesherbal.com/eclectic/potter-comp/index.html | access-date = 2007-10-13 | chapter = Opium | chapter-url = http://www.henriettesherbal.com/eclectic/potter-comp/papaver-somn.html | ref =Potter }}</ref><ref>{{cite book | title = Licit & Illicit Drugs | last = Brecher | first = EM | author-link = Edward M. Brecher | location = Boston, USA | publisher = Little, Brown | year = 1972 | chapter = Chapter 1: Nineteenth-century America{{mdash}}a 'dope fiend's paradise' | pages = 3–7 }}</ref> The limited [[pharmacopoeia]] of the day meant that opium derivatives were among the most effective of available treatments, so laudanum was widely prescribed for ailments from [[common cold|colds]] to [[meningitis]] to [[heart|cardiac]] [[disease]]s, in both adults and children. Laudanum was used during the [[yellow fever]] [[epidemic]].

Innumerable Victorian women were prescribed the drug for relief of [[Dysmenorrhea|menstrual cramps]] and vague aches. Nurses also spoon-fed laudanum to infants. The [[Romanticism|Romantic]] and [[Victorian era|Victorian]] eras were marked by the widespread use of laudanum in Europe and the United States. [[Mary Todd Lincoln|Mary Lincoln]], for example, the wife of the US 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 on business from Porlock]]".<ref>{{cite web|url=http://lincoln.coffeetownpress.com/|title=Camel Press|website=lincoln.coffeetownpress.com}}</ref> 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]].

As one researcher has noted: "To understand the popularity of a medicine that eased{{mdash}}even if only temporarily{{mdash}}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]], [[Tuberculosis|consumption]], [[Fever|ague]] and [[rheumatism]] were all too common.<ref name="Hodgson_2001" />{{rp|44–49}}

An 1869 article in ''[[Scientific American]]'' describes a farmer growing and harvesting [[poppy]] in [[Indian Springs, Georgia]], and subsequently selling the raw material to a local pharmacist who prepared laudanum.<ref>{{Cite book |url=https://books.google.com/books?id=RmM9AQAAIAAJ&q=carbonic+oxide |title=Scientific American |date=1869-05-29 |publisher=Munn & Company |pages=342 |language=en}}</ref>

=== 20th century ===
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 [meaning as an [[enema]]] every six to twelve hours"; (2) Tincture rhubarb, 1 ounce; Laudanum 4 [[Dram (unit)|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, 1{{1/2}} 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."<ref>{{cite book |title=Medicology or Home Encyclopedia of Health |vauthors=Richardson JG |date=1901 |publisher=University Medical Society |location=New York, Philadelphia and London |pages=1276 and 1282}}</ref>

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".<ref name="Hodgson_2001" />{{rp|126}} In the US, the [[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.<ref>{{cite book|url=https://books.google.com/books?id=7VrQy2d8PxYC | vauthors = Musto DF |author-link=David F. Musto|year= 1999|edition=3rd|title=The American Disease: Origins of Narcotic Control|publisher= [[Oxford University Press]]|isbn=9780198028925}}</ref> In 1906 in Britain and in 1908 in [[Canada]] "laws requiring disclosure of ingredients and limitation of narcotic content were instituted".<ref name="Hodgson_2001" />{{rp|126}}

The [[Harrison Narcotics Tax Act]] of 1914 restricted the manufacture and distribution of opiates, including laudanum, and [[coca leaf|coca]] derivatives in the US. This was followed by France's ''{{lang|fr|Loi des stupéfiants}}'' in 1916, and Britain's Dangerous Drugs Act in 1920.<ref name = "Hodgson_2001" />{{rp|126}}

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.<ref>{{cite report | publisher = Frank S. Betz Co. | date = 1915 | title = Catalog No. N-15 | edition = Second | location = Hammond, Indiana, USA | page = 320 }}</ref> 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) Papaver Somniferum" for $2.25 per pint.<ref>{{cite report | publisher = Frank S. Betz Co. | date = 1915 | title = Catalog No. N-15 | edition = Second | location = Hammond, Indiana, USA | page = 318 }}</ref>

In 1929–30, Parke, Davis & Co., a major US 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".<ref>{{cite report | date = 1929–1930 | title = Physicians' Catalog of the Pharmaceutical and Biological Products of Parke, Davis & Company | pages = 87–88 }}</ref> 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 [[opioid]]s, 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. Until now, there has been no medical consensus on which of the two (laudanum or morphine alone) is the better choice for treating pain.

In 1970, the US adopted the [[Uniform Controlled Substances Act]], which regulated opium tincture (Laudanum) as a [[Controlled Substances Act#Schedule II controlled substances|Schedule II]] substance (currently DEA #9630),<ref>{{cite web|url=https://www.justice.gov/dea/pubs/scheduling.html | title = List of Controlled Substances | work = Office of Diversion Control | publisher = Drug Enforcement Administration, United States Department of Justice | quote = Also under Schedule II are opium extracts, opium fluidextract, opium poppy (''Papaver somniferum''), granulated opium, powdered opium, and raw or gum opium, each with an individual DEA number.|access-date=August 1, 2010|archive-url=https://web.archive.org/web/20130629153729/http://www.justice.gov/dea/pubs/scheduling.html|archive-date=June 29, 2013|url-status=dead}}</ref> placing even tighter controls on the drug.

By the late 20th century, laudanum's use was almost exclusively confined to treating severe [[diarrhea]].

=== 21st century ===
The current prescribing information for laudanum in the US states that opium tincture's sole indication is as an anti-diarrheal, although the drug is occasionally prescribed [[off-label]] for treating pain and [[neonatal withdrawal syndrome]].{{Citation needed|date=December 2022}}