Health Care and Drugs

It’s often distressing to read 19th century advertisements.  Our great-great grandparents  were just as desperate (and gullible) when it comes to certain aspects of the human condition. Hair loss, for example.

Medications in general use in the 19th century include

  • Anesthetics – such as ether.
  • Anodynes – or narcotic pain relievers such as opium and morphine.
  • Antiperiodics – such as quinine and arsenic which were used to stop the recurring fevers of malaria. Quinine was a successful treatment, but arsenic is a poison.
  • Astringents – which helped blood to clot and decreased hemorrhaging.
  • Cathartics or purgatives – such as calomel which had the same effect as a laxative. Calomel though was a mercury based poison which did more harm than good. Harmful effects included tooth loss, painful and bleeding gums, and mouth ulcers. Even more serious, it could cause cell damage and tissue loss which could lead to a deformity or a disabling injury.
  • Depressants or sedatives – which calmed or tranquilized.
  • Diaphoretics and sudorifics – to induce sweating.
  • Diuretics – which increased urination.
  • Emetics – which induced vomiting.
  • Emollients – which softened or soothed the skin or an irritated area beneath the surface of the skin.
  • Escharotics –  Escharotic agents are caustic, corrosive salves, pastes, poultices and plasters that are purported to destroy cancer cells and cure skin cancers including basal cell carcinomassquamous cell carcinomas and melanomas. They are called escharotics because they produce a thick black, dry scab called an “eschar” on the skin.
  • Expectorants – to break up congestion.
  • Stimulants – such as brandy, gin, wine, whisky rum and spirits of ammonia. 
  • Tonics – are supposed to restore or improve health or well-being
  • Alcohol – used as a stimulant and as a rubefacient to induce blistering.
  • Spirits of ammonia – inhaled as a stimulant. It was diluted and used internally to prevent spasms.
  • Ether – developed during the Mexican War. Used as an anesthetic. Ether was a safe anesthetic, but it smelled bad and was slow acting
  • lpecac – a strong emetic that stimulates vomiting. It was also used as a stimulant, diaphoretic (to induce sweating) and an expectorant. It was often mixed with opium to be used as a painkiller and a diaphoretic. This mixture was called Dover’s Powder.
  • Lead Acetate – used to treat dysentery in the 1840s. It was an astringent used to stop bleeding, but was also poisonous.
  • Opium and Morphine – used for pain relief and muscle relaxation. Opium was also used for dysentery.
  • Quinine – made from cinchona tree bark, specific for malaria. Used for all types of fevers, but was only effective on malaria.
  • Sodium chlorate – used to cool the skin and as a skin wash. Taken internally as a diuretic.
  • Oil of Turpentine – used internally as a stimulant, to kill intestinal worms, and as a purgative. It could be used externally as a blistering agent.
  • Creosote – used externally as an antiseptic; it helped to stop bleeding and destroyed infected tissue. Taken internally it could be used as an expectorant which loosened up phlegm.
  • Black Tea – used as a stimulant and to soothe abdominal discomforts.
  • Glycerin – used primarily to sooth skin, but was also used in cough syrup.

Usually included in a medical bag:

  • Ammonia Water – used as a stimulant, an antacid, to induce sweating and externally as a blistering agent.
  • Alum – used to clot blood, to induce vomiting and purging, and to prevent spasms. Also used as a mouthwash and gargle for mouth ulcers.
  • Beef Extract – nutrient used in cases of diarrhea and dysentery.
  • Coffee Extract – a stimulant used in cases of diarrhea and dysentery.
  • Ferric Sulphate – used to clot blood and was also used as a tonic in solution form.
  • Liniment – used to relieve skin irritations which sometimes included blistering in order to bring irritated areas beneath the skin to the surface.
  • Silver Nitrate – used internally as a tonic, for gastric or stomach discomfort, and to prevent spasms associated with epilepsy and other spasmodic diseases. Used externally as a blistering agent, to cauterize wounds, and in the treatment of gangrene.
  • Spirit of Nitrous Ether – induces urination and sweating and also used as an antispasmodic.
  • Tannic Acid – used internally to combat diarrhea and used externally as an astringent or blood clotting agent.
  • Tincture of Ferric Chloride – potent tonic and diuretic.

Specific Medications

Paregoric

Nobody likes a crying baby. Parents don’t like their kids to be in pain or distress, and strangers are often pretty intolerant. Do a google search and you’ll see that this is a perennial problem with no easy solution. Sometimes babies just cry. Sometimes babies get really sick, and they scream.  Sometimes overwrought caregivers are driven to extremes. There is no excuse for that, but it happens. It happened then, too.

What’s most disturbing about the 19th century is how unaware they were of the dangers of doping their children. Have a look at this handy dandy cure for the crying baby available at every drugstore.

Stickney & Poor-Paregoric
Stickney & Poor’s Paregoric

It’s a challenge to stay in the mindset of your characters when you’re writing historical fiction.  An intelligent, sensible person who truly believes that there’s nothing dangerous about smoking, or a little laudanum is just what the baby needs, that is sometimes hard to pull off.  I consider it a kind of anachronism to pretend a character understood something that was just not knowable at the time, but I struggle with it.

Of course there were quacks who knew very well that what they were selling would do nobody any good. For instance this cure for male weakness. Note the positioning.

Laudanum

Historical varieties (Wikipedia)

Several historical varieties of laudanum exist, including Paracelsus’ laudanum, Sydenham’s Laudanum (also known as tinctura opii crocata), benzoic laudanum (tinctura opii benzoica), and deodorized tincture of opium (the most common contemporary formulation), among others. Depending on the version, additional amounts of the substances and additional active ingredients (e.g. saffron, sugar, eugenol) are added, modifying its effects (e.g., amount of sedation, or anti-tussive properties).
There is probably no single reference that lists all the pharmaceutical variations of laudanum that were created and used in different countries during centuries since it was initially formulated. The reasons are that in addition to official variations described in pharmacoepias, pharmacists and drug manufacturers were free to alter such formulas. The alcohol content of Laudanum probably varied substantially; on the labels of turn-of-the-century bottles of Laudanum, alcoholic content is stated as 48%. In contrast, the current version of Laudanum contains about 18% alcohol.

Opium v. Tincture of Opium

ISMP urges hospitals, community pharmacies, and other locations that use opium tincture and/or paregoric (camphorated tincture of opium) to take action immediately to minimize the risk of fatal confusion between these drugs. Last week, a Connecticut newspaper reported that a 51-year-old woman with chronic diarrhea died from morphine intoxication after receiving a teaspoonful of opium tincture (about 50 mg morphine) instead of paregoric. After a dose, the patient became weak, tired, and achy. Her son checked on her periodically, but when he tried to wake her later that day, she did not respond. Paramedics were summoned but they could not revive the woman.

The patient’s physician had prescribed “camphorated tincture of opium.” A recent pharmacy graduate confused this with opium tincture. Paregoric has been used for many years to control diarrhea in children and adults. However, it often is dangerously referred to by its synonym, camphorated tincture of opium, which can be confused easily with opium tincture, a compound that contains 25 times the amount of morphine. Paregoric has just 0.4 mg/mL of morphine while opium tincture contains 10 mg/mL. This is a potentially dangerous situation that invites serious medication errors. We’ve previously described such confusion in the June 19, 1996; Oct 8, 1997; September 5, 2001; and October 3, 2001, issues of ISMP Medication Safety Alert!.”

Contemporaneous comments on opiates:

“Drs. Van Hoevenbergh and Allen’s trials of the Elixir of Opium in the Bellevue Hospital.
This is to certify that Dr. J. B. McMunn’s Elixir of Opium has been used in several cases at the Bellevue Hospital, with the most satisfactory effects, when the usual preparations of Opium would have proved injurious. The undersigned are fully convinced that it possesses the sedative properties of the latter, without producing constipation of the bowels, or any unpleasant symptoms. HENRY VAN HOEVENBERGH, Resident Physician, Bellevue Hospital. GEORGE F. ALLEN, Assistant Physician.  [Testimonials] [184-?]. http://www.loc.gov/ resource/rbpe.11901200 Bellevue, New York, Feb. 19, 1837.”

Selected Sources

Schaadt, Mark J. 1998. Civil War Medicine: An Illustrated History

Wilburg, C. Keith. Civil War Medicine: 1861-65  (online)

Wikipedia

 

 

 

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