By this time the European category of drugs, locked in stasis since antiquity, was being expanded by global exploration. Poppies and nightshades were now augmented by the spectacular pharmacopeia of the New World: the appearance of tobacco and chocolate was accompanied by tales of the coca leaf chewed by the Indians to banish sleep and hunger, and the mushrooms that the Aztecs ate to commune with the Devil. From the Arab world came descriptions of pastes and ointments that took their subjects to fantastical worlds of beauty and terror - but also, from its alchemists and physicians, a new chemical understanding of the essences to which the healing power of plants could be reduced. Their techniques, notably distillation, generated concentrated acids, alcohols and solvents that had the power to unlock the secrets of nature in ways thus far unimagined.
The figure who became emblematic of the quest to transform Western medicine with these new drugs and ‘essences’ was Theophrastus von Hohenheim, better known as Paracelsus, an itinerant Swiss alchemist and physician who gained a larger-than-life reputation from his exotic travels and outspoken criticism of classical authority. From 1517 until his death in 1541, he traversed Europe and the Near East, from Moscow to Lisbon Oxford to Jerusalem, proclaiming that the medicine of the ancients was no longer sufficient to the modern age. In its place he offered concentrated and refined substances - vitriols, elixirs, powdered metals in distilled alcohol - which he described as ‘nature fortified beyond its grade’. Some were powerful narcotics: his ‘sweet oil of sulphur’, apparently produced by distilling alcohol with sulphuric acid, was most likely ether, a potent intoxicant that would eventually transform surgery as an anaesthetic. Paracelsus himself noted that it sent chickens into a swooning sleep, and extinguished all pain for the duration.
Though often marginalized and ignored during his lifetime, Paracelsus’s reputation grew after his death, helped by the posthumous publication of his complex and original writings and by a growing band of
‘Paracelsians’ who promoted his chemical therapies. Among these was laudanum, a tincture of opium in alcohol that Paracelsus had frequently hailed as a panacea, and which his followers prescribed widely for pain relief and sleep, for which it was marvellously effective. In fact, it is unclear precisely what Paracelsus’s laudanum was: he seems to have used the term for several different preparations, not all containing opium, and also for a type of mastic gum more commonly known as ladanum. But opium had certainly been one of his staples, and laudanum was a fitting and effective symbol for his campaign to employ the products of nature in their most potent forms.
In alchemical works such as his posthumously published Archidoxa (1541) Paracelsus advocated the use of new techniques, including distillation, to reduce natural substances to chemical ‘spirits’ or ‘quintessences’ with powerful ‘virtues’ unknown to the ancients. (Wellcome Library, London)
It was Thomas Sydenham, however, who popularized laudanum, and whose recipe would become the standard preparation. Sydenham was a physician who practised in seventeenth-century London, through civil war, fire and plague, dying shortly after the Glorious Revolution in 1689. He was known as ‘the English Hippocrates’ for his belief that medicine was about close observation of patients rather than dogmatic theories, but he was a Paracelsian in his conviction that there were powerful new remedies waiting to be discovered. He earned the epithet ‘Opiophilos’ for the regard in which he held opium: the queen of medicines, revered since antiquity, unequalled in the relief of pain, the suppression of coughs and respiratory ailments, the treatment of diarrhoeia and dysentery and the provision of deep and refreshing sleep. Many doctors and apothecaries mixed their own laudanums, but Sydenham’s preparation was considered the best: two ounces of opium in a pint of strong red wine or port, spiced with saffron, cloves and cinnamon. For two centuries, pharmacy jars filled with this rusty tincture would be decorated in gold leaf with the motto Laudanum Sydenhamii.
Thomas Sydenham popularized effective new medicines including laudanum, and the Peruvian chinchona bark as a treatment for malaria, but he also maintained a Hippocratic scepticism about the limits of drugs: the best thing a physician could do for his patients in many cases, he wrote, was ‘nothing at all’. (Wellcome Library, London)
The standardization of laudanum was a significant step in the emergence of recognizably modern drugs. Until this point, all drugs had been subject to the vagaries of nature. Their strength varied with the seasons, the habitat where the plant had grown and how it had been dried, cured and stored. From this point, in theory at least, purity and dosage were subject to human control, and each batch could be the same as the last. Standardized products could be supplied to a mass market at levels of purity and potency never before possible, and the mass market for drugs was booming. In 1732 the adventurer-turned-physician Thomas Dover, who claimed to have served an apprenticeship under the now legendary Dr Sydenham, offered to the general public a preparation even more
Convenient than his master’s: Dover’s Powder. Dover’s innovation was to powder opium finely and mix it with liquorice and ipecacuana, a South American emetic, to ensure that if too much was taken inadvertently it would be vomited up rather than cause a fatal overdose.
Laudanum bottles from the nineteenth century still commonly referred to the preparation as
‘Sydenham’s Laudanum’ or ‘Laud. Syd.’ (left and centre). This bottle of Dover’s Powder (right) was part of the medicine chest supplied by the Burroughs Wellcome Company to the British National Antarctic Expedition of 1901. (Left and centre: Science Museum/SSPL; right: Wellcome Library, London)
Dover’s Powder represented another conceptual leap: not simply a standardized preparation, but a commoditized product. Where Sydenham’s laudanum needed to be decanted fTom the pharmacist’s jar into the patient’s bottle, Dover’s product could be displayed on the shelves of any high street grocer, already bottled up ready for purchase, complete with safety guarantee. It sold briskly, and continued to do so for centuries until it was finally removed from pharmacy shelves in the 1930s.
Standardized preparations of laudanum and other drugs relieved apothecaries of the need to carry a complex array of measures to provide consistent doses, as shown in this German engraving from 1721. (Wellcome Library, London)
World History
