Sedation in the year 1830
July 29, 2019 9:35 AM Subscribe
What sedative would a European doctor in the year 1830 have administered to well off patients? Let‘s say he has access to the newest scientific developments and money is not an issue.
What would the effect of that sedative be like?
What would the effect of that sedative be like?
Response by poster: I forgot to add: sedatives and/or sopoforics, sorry!
posted by Omnomnom at 9:41 AM on July 29, 2019
posted by Omnomnom at 9:41 AM on July 29, 2019
Response by poster: mumimor, would ether be available outside of hospital settings?
posted by Omnomnom at 9:42 AM on July 29, 2019
posted by Omnomnom at 9:42 AM on July 29, 2019
Oh yes, rich people rarely went to hospitals, regardless of what the diagnosis was.
posted by mumimor at 9:44 AM on July 29, 2019
posted by mumimor at 9:44 AM on July 29, 2019
And sedatives weren't regulated in any way. My great-grandmother was an opium addict, and it wasn't a legal problem at all.
posted by mumimor at 9:45 AM on July 29, 2019
posted by mumimor at 9:45 AM on July 29, 2019
1830 is still just a bit early for ether. Chloroform, too.
The first documented successful medical procedure using an anesthetic was in Japan, only about 25 years earlier, using a plant relative of nightshade, but even a real fancy European wouldn't know about that, since it was Japan and they were pretty good at not talking to people at the time.
Nitrous oxide would be believable, but it definitely wasn't in medical practice for at least a decade after. Is this for a story? I think it would be entirely believable that fancy rich European people at parties would know someone who knew someone who had had an experience with laughing gas, and that a really pioneering doctor might give it a try.
posted by phunniemee at 10:08 AM on July 29, 2019
The first documented successful medical procedure using an anesthetic was in Japan, only about 25 years earlier, using a plant relative of nightshade, but even a real fancy European wouldn't know about that, since it was Japan and they were pretty good at not talking to people at the time.
Nitrous oxide would be believable, but it definitely wasn't in medical practice for at least a decade after. Is this for a story? I think it would be entirely believable that fancy rich European people at parties would know someone who knew someone who had had an experience with laughing gas, and that a really pioneering doctor might give it a try.
posted by phunniemee at 10:08 AM on July 29, 2019
Laudanum and morphine (both opium derivatives) were available by 1830.
Might be helpful to know more about the context - is this a "take one of these every day to calm yourself down" kind of thing, or more of a "we need to knock you out right now" thing?
posted by mskyle at 10:13 AM on July 29, 2019 [3 favorites]
Might be helpful to know more about the context - is this a "take one of these every day to calm yourself down" kind of thing, or more of a "we need to knock you out right now" thing?
posted by mskyle at 10:13 AM on July 29, 2019 [3 favorites]
Response by poster: More the „knock you out right now“ kind, but I would like to know about the other kind as well.
posted by Omnomnom at 10:14 AM on July 29, 2019
posted by Omnomnom at 10:14 AM on July 29, 2019
Laudanum figures prominently in Patrick O'Brian's Aubrey-Maturin novels, which are set just before the 1830s and are known to be very meticulously researched. Maturin, the ship's doctor, administers it to patients when performing amputations.
posted by jquinby at 10:28 AM on July 29, 2019 [3 favorites]
posted by jquinby at 10:28 AM on July 29, 2019 [3 favorites]
Use of laudanum and coca leaves for pain relief play a role in Patrick O'Brien's Aubrey-and-Maturin historical novels, set at the beginning of the 1800s.
posted by They sucked his brains out! at 10:32 AM on July 29, 2019
posted by They sucked his brains out! at 10:32 AM on July 29, 2019
Laudanum, morphine and straight opium were very much in vogue. Opium will make you unconscious in large doses but at that dosage, you do also run the risk of death. Here is a timeline of anesthetics through history.
You really want chloroform, but that wasn't used as an anesthetic until 1842.
posted by DarlingBri at 10:33 AM on July 29, 2019
You really want chloroform, but that wasn't used as an anesthetic until 1842.
posted by DarlingBri at 10:33 AM on July 29, 2019
Laudanum was handed out like candy back then. Stressed? Laudanum.
You should really check out the television show "The Knick". It takes place a little later, but it's all about the first hospitals and doctors and drugs in New York.
posted by xammerboy at 10:34 AM on July 29, 2019 [1 favorite]
You should really check out the television show "The Knick". It takes place a little later, but it's all about the first hospitals and doctors and drugs in New York.
posted by xammerboy at 10:34 AM on July 29, 2019 [1 favorite]
Response by poster: Thank you so much for the help!
I would be very grateful to any other description of how much and in what form laudanum or morphine would be taken to knock someone out.
Would a doctor use a syringe with ??? miligrams in it? Or is that an anachronism?
posted by Omnomnom at 11:11 AM on July 29, 2019
I would be very grateful to any other description of how much and in what form laudanum or morphine would be taken to knock someone out.
Would a doctor use a syringe with ??? miligrams in it? Or is that an anachronism?
posted by Omnomnom at 11:11 AM on July 29, 2019
Well, whatever it would be, it wouldn't be measured in mg.
posted by praemunire at 11:13 AM on July 29, 2019
posted by praemunire at 11:13 AM on July 29, 2019
Response by poster: Ooooh, I dug around some more and found this reddit answer which is very helpful. Posted for posterity:
posted by Omnomnom at 11:27 AM on July 29, 2019
posted by Omnomnom at 11:27 AM on July 29, 2019
Laudanum was a liquid and it was administered by the teaspoon; your doctor would give it to you in bottles, or you could buy it over the counter. People also used morphine, heroin and/or cocaine douches for menstrual cramps -- THOSE WERE THE DAYS, BOY -- so I assume it was the powered form mixed with whatever Georgian ladies douched with. I mean, in my imagination it's the perfect concoction of morphine, cocaine and lavender water but probably not.)
I'm not an expert by any means but one of my dads is an anesthesiologist with an interest in history, and I myself have an amateur interest in things women have shoved up their hoohas through history <3
posted by DarlingBri at 12:37 PM on July 29, 2019 [3 favorites]
I'm not an expert by any means but one of my dads is an anesthesiologist with an interest in history, and I myself have an amateur interest in things women have shoved up their hoohas through history <3
posted by DarlingBri at 12:37 PM on July 29, 2019 [3 favorites]
In O'Brian's books, laudanum dosage is measured in drops, administered (presumably) orally. Maturin is an addict himself and takes ludicrously large dosages. From The Letter of Marque:
'What would you consider a moderate dose, Maturin?' asked Martin, in a spirit of pure inquiry. He knew that the usual amount was twenty-five drops and he had seen Stephen give Padeen sixty to do away with extreme pain; but he also knew that habitual use might lead to a considerable degree of tolerance and he wished to learn how high that degree might be.posted by jquinby at 12:47 PM on July 29, 2019
'Oh, nothing prodigious at all, for one accustomed to the substance. Not above...not above say a thousand drops or so.'
Martin checked his horrified expression and to conceal even its apparance he hailed a passing hackney-coach.
There really wasn't anything other than laudanum, in liquid form. Read up on the War between the States. Even in the 1860s there was nothing else. Queen Victoria was the first woman ever to have chloroform during childbirth.
posted by Enid Lareg at 12:50 PM on July 29, 2019 [2 favorites]
posted by Enid Lareg at 12:50 PM on July 29, 2019 [2 favorites]
Side effects of laudanum usage include extreme thirst when awakening after taking it, at least according to the historical fiction I've read set in pre-Victorian times.
Opium derivatives like laudanum and morphine, and opium itself also cause constipation, sometimes severe. Paregoric, or tincture of opium used to be available over the counter at pharmacies in the USA (as recently as the 1970s. I used it for menstrual cramps on the recommendation of a friend in college.) and is used for diarrhea even now. Paregoric is much less potent than laudanum, but they are both tinctures of opium. I work with heroin users, and diarrhea and nausea is something they experience whenever they are in withdrawal. When using opiates consistently they typically experience constipation. Interestingly, I've never heard users complain of thirst, so perhaps that is limited to laudanum? Or perhaps thirst is so unremarkable that it's not noticed by addicts now.
If you are writing fiction this might be more atmosphere than you need, but opiates are an interesting substance, and the history of opium has spawned both misery and relief throughout history.
posted by citygirl at 1:25 PM on July 29, 2019 [1 favorite]
Opium derivatives like laudanum and morphine, and opium itself also cause constipation, sometimes severe. Paregoric, or tincture of opium used to be available over the counter at pharmacies in the USA (as recently as the 1970s. I used it for menstrual cramps on the recommendation of a friend in college.) and is used for diarrhea even now. Paregoric is much less potent than laudanum, but they are both tinctures of opium. I work with heroin users, and diarrhea and nausea is something they experience whenever they are in withdrawal. When using opiates consistently they typically experience constipation. Interestingly, I've never heard users complain of thirst, so perhaps that is limited to laudanum? Or perhaps thirst is so unremarkable that it's not noticed by addicts now.
If you are writing fiction this might be more atmosphere than you need, but opiates are an interesting substance, and the history of opium has spawned both misery and relief throughout history.
posted by citygirl at 1:25 PM on July 29, 2019 [1 favorite]
I think the single most likely answer to this question in 1830 would be a stiff drink of brandy or other spirits.
posted by kickingtheground at 2:36 PM on July 29, 2019 [1 favorite]
posted by kickingtheground at 2:36 PM on July 29, 2019 [1 favorite]
Laudanum is a tincture -- a solution with ethanol as the solvent -- of opium. As such, it could vary in strength depending on how it was prepared. The drop-based dosage was therefore specific to a particular preparation. The dispensing physician would need to know how the tincture had been prepared, or have prepared it themselves, to know what dosage to use.
Thomas Sydenham -- who published one of the first widely distributed medical textbooks in Britain -- described a preparation for it in the 17th century that apparently became common. He used opium, cinnamon, cloves, and saffron (this stuff would go great in a risotto) tinctured in a sherry (again, this stuff sounds delicious) alcohol solvent.
One recipe for it is as follows:
This paper may be of interest, if you can access it.
posted by Kadin2048 at 3:11 PM on July 29, 2019
Thomas Sydenham -- who published one of the first widely distributed medical textbooks in Britain -- described a preparation for it in the 17th century that apparently became common. He used opium, cinnamon, cloves, and saffron (this stuff would go great in a risotto) tinctured in a sherry (again, this stuff sounds delicious) alcohol solvent.
One recipe for it is as follows:
[M]acerating, for 2 weeks, 2 ounces of opium, 1 ounce of saffron, and 1 drachm, each, of bruised cinnamon and cloves in 1 pint of sherry wine; then filter. A fluid drachm of this laudanum is equivalent to 3 grains of opium.This is allegedly taken from the "Parisian Codex" and dates to 1660. I'm not sure whether the dosage note (equal to 3 gr. opium) is actually from the original text or not.
This paper may be of interest, if you can access it.
posted by Kadin2048 at 3:11 PM on July 29, 2019
I don't know how you would go about finding it if you were interested, but NOVA did a show on the discovery of general anesthetics way back in either the late 70's or early 1980. (I watched a VHS tape of the show on a top loading VHS tape player the size of a big samsonite suitcase at a learning center at Fort Gordon, Georgia, late in 1980). The show started with a dramatization of a surgical amputation where an injured dockworker with the crushed and gangrenous leg was given a shot of brandy, a stick to bite on, and a couple of strong men to hold him down. The surgeon was demonstrating to medical students and the focus was on speed. Later in the show they dramatized the discovery of ether. Ether was, I think, the first "knock you out right now" general anesthetic. The episode was called "The Mysterious Sleep" or something like that. The show also spoke briefly about the cultural attitudes towards anesthesia as it became available for use.
posted by coppertop at 5:57 PM on July 29, 2019 [1 favorite]
posted by coppertop at 5:57 PM on July 29, 2019 [1 favorite]
One of the really interesting things is that ether, the first anaesthetic used in western clinical practice was first synthesised in the medieval period (Royal College of Anaesthetists says 13th century, but I'm sure I've read 15th elsewhere), and it was noted to have soporific effects at the time... and then nothing. There is absolutely no evidence of it being used medically until the 19th century. So if this is a fictional setting and you really, really want to anaesthetise someone, you could introduce some rogue maverick chemist who has this brilliant idea about using ether a bit over a decade before some people historically actually did have the idea.
If you want to really deep-dive the subject, both the Lancet and the British Medical Journal have made their historic issues freely searchable online; the Lancet started publication in 1823 and (what would later be) the BMJ in 1840. Links to searches for the word "morphine" up until 1850 in the Lancet and the BMJ (of course you can search for whatever terms you want). Spoiler: early 19th century medicine was utterly terrifying.
posted by Vortisaur at 5:08 AM on July 30, 2019
If you want to really deep-dive the subject, both the Lancet and the British Medical Journal have made their historic issues freely searchable online; the Lancet started publication in 1823 and (what would later be) the BMJ in 1840. Links to searches for the word "morphine" up until 1850 in the Lancet and the BMJ (of course you can search for whatever terms you want). Spoiler: early 19th century medicine was utterly terrifying.
posted by Vortisaur at 5:08 AM on July 30, 2019
Aside as cultural attitudes to anaesthesia have been mentioned above - I seriously love the surgeon Robert Liston's comment after undertaking the first operation under ether in the UK: “This Yankee dodge beats mesmerism hollow!”
posted by Vortisaur at 5:11 AM on July 30, 2019
posted by Vortisaur at 5:11 AM on July 30, 2019
1830 is a little too early for ether to be in wide use. It's possible there were doctors experimenting with it, but the first public demonstration of its use in surgery wasn't until 1846 in Boston. Nitrous Oxide (laughing gas) would have been the main drug used for surgical anesthetic (at least if you had a doctor or dentist who was up on the latest developments) but it doesn't have a sedative effect.
Most likely some form of opiate would be used, whether smoked, injected (as morphine) or dissolved in alcohol (laudanum and various drugged wines).
posted by firechicago at 10:10 AM on July 30, 2019
Most likely some form of opiate would be used, whether smoked, injected (as morphine) or dissolved in alcohol (laudanum and various drugged wines).
posted by firechicago at 10:10 AM on July 30, 2019
You might be interested in this account of surgery in the era before anesthesia by Michael Brown.
Particularly interesting there is the case of Frances Burney's mastectomy.
Burney wasn't super-wealthy herself, but she was well-off-ish and very well connected. Her surgeon was known as the best doctor in France and was Obstetrician to the Empress.
So presumably Burney received the same treatment the royals did.
There is no mention of any sedatives or painkillers of any type, not even alcohol or opioids.
(Of course there is the possibility that some of those things were used, but not mentioned for one reason or another.)
Also note these very interesting quotes from the Brown article:
Particularly interesting there is the case of Frances Burney's mastectomy.
Burney wasn't super-wealthy herself, but she was well-off-ish and very well connected. Her surgeon was known as the best doctor in France and was Obstetrician to the Empress.
So presumably Burney received the same treatment the royals did.
There is no mention of any sedatives or painkillers of any type, not even alcohol or opioids.
(Of course there is the possibility that some of those things were used, but not mentioned for one reason or another.)
Also note these very interesting quotes from the Brown article:
Martin S. Pernick challenged the widespread popular perception that anaesthesia brought about a sudden, near miraculous, end to hundreds of years of agonising surgery, demonstrating instead how the volatility and unpredictability of early anaesthetics, as well as the continued resonance of pain as an indicator of sensibility, meant that many practitioners were extremely cautious about how, and with whom, they employed them. As he also demonstrates, understandings of pain were shaped by a complex ‘social politics’ of class, race and gender, something which has also been borne out by Stephanie Snow in her study of anaesthesia in the UK. More recently still, in her broad account of the history of pain, Joanna Bourke acknowledges the traditional image of pre-modern medicine as cruel or uncaring before suggesting that sympathy might actually have played a more important social and rhetorical function than has generally been recognised. . . .posted by flug at 2:50 PM on July 30, 2019
shaped by the cultures of Enlightenment sensibility, early nineteenth-century surgeons, who were increasingly turning their backs on the heroic surgery of the preceding era, reframed the notion of what it was to be a good surgeon, combining, if not necessarily displacing, the physical model of the ‘capital operator’ with the moral ideal of the man of feeling who could not simply amputate a limb in under a minute, but who, in the most profound sense, was capable of sympathising with his patients and who sought at all times to minimise their pain and suffering. Needless to say, this transformation in identities and practices had a complex set of origins, but it was a profoundly political process. . . . within this context, the pain and suffering of patients could, when presented as the corollary of incompetence and corruption, form a powerful critique of a nepotistic and monopolistic surgical oligarchy.
I just read the complete manuscript letter by Frances Burney, that describes in detail the preparations in the weeks leading up to the operation and the operation itself. It was both gripping as a personal account and also invaluable if you happen to be interested in the details of medicine as practiced at that time (1811).
The full manuscript along with other interesting documents are here.
Transcribed copies (both partial for one reason or another) here and here.
I do have to amend my statement above--according to the letter, the sedation she received from Dr. Moreau was "a wine cordial."
So there we have it.
posted by flug at 7:56 PM on July 30, 2019 [1 favorite]
The full manuscript along with other interesting documents are here.
Transcribed copies (both partial for one reason or another) here and here.
I do have to amend my statement above--according to the letter, the sedation she received from Dr. Moreau was "a wine cordial."
So there we have it.
posted by flug at 7:56 PM on July 30, 2019 [1 favorite]
He used opium, cinnamon, cloves, and saffron (this stuff would go great in a risotto) tinctured in a sherry (again, this stuff sounds delicious) alcohol solvent.
Oh my God, opium risotto! I AM SO HERE FOR THAT.
posted by DarlingBri at 4:57 AM on July 31, 2019 [2 favorites]
Oh my God, opium risotto! I AM SO HERE FOR THAT.
posted by DarlingBri at 4:57 AM on July 31, 2019 [2 favorites]
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posted by mumimor at 9:41 AM on July 29, 2019