Tomorrow is without a doubt a notable anniversary of an important medical discovery by Freidrich Wilhelm Adam Serturner. The University of Chicago Medical Center strikes a chord:
On May 21, 2005, the world of medicine will celebrate the 200th anniversary of the crystallization of morphine in Einbeck, Germany. Since 1805, morphine and its derivatives have become the most widely used treatment for severe pain. Now more than 230 tons of morphine is used each year for medical purposes including pain relief for patients with chronic pain or advanced medical illness and post-operative analgesia.
Although many new pain relievers have been synthesized since the crystallization of morphine from opium almost 200 years ago, “morphine remains the standard against which all new medications for postoperative pain relief are compared,” notes Jonathan Moss, M.D., Ph.D., professor of anesthesia and critical care at the University of Chicago.
An article by Hamilton and Baskett in the Canadian Journal of Anesthesia gives more details of the story:
Laudanum, or tincture of opium, was a mixture of opium, alcohol, and various other ingredients. It was often given in whiskey or rum and became a widely used agent to prepare patients for surgery until the discovery of effective anesthesia. There were many recipes for laudanum, the most famous being that of Thomas Sydenham (1624-89). Sydenham’s recipe, given in his work on dysentery in 1669, contained 1 pound sherry wine, 2 ounces opium, 1 ounce saffron, 1 ounce powder of cinnamon, and 1 ounce powder of cloves. Sydenham’s laudanum was used in Europe and North America into the early 20th century. Several other opioid preparations were popular in the 18th and 19th centuries. “Black-drop”, otherwise known as Lancaster or Quaker’s Black Drop, contained opium, verjuice, nutmeg, saffron and yeast, and was reputedly three times stronger than laudanum. Paregoric was a weaker preparation, named after the Greek word for “soothing” or “consoling” and included opium, honey, licorice root, camphor, aniseed and wine. Dover’s powder, first developed by the English physician and buccaneer Thomas Dover (1660-1742), contained opium, salt peter, tartar, licorice and ipecacuanha. Dover claimed, “In two or three hours at furthest the patient will be free from pain”. In addition to producing his opium-containing “sweating powder”, Thomas Dover was the second captain aboard the privateer Duke that rescued Alexander Selkirk (Robinson Crusoe) from one of the Juan Fernandez islands in 1709.
The first record of postoperative analgesia was the use of opium in 1784 by the Glasgow-born London surgeon James Moore (1763-1834). He clearly realized the limitations of opium for surgical anesthesia, but praised its postoperative benefits when he wrote: “Opium…is highly expedient to abate the smarting of the wound after the operation is over, and to induce sleep; but the strongest dose we dare venture to give has little or no effect in mitigating the suffering of the patient during the operation”. In the same year, Moore also devised an appliance for compression of nerves producing numbness in a limb before surgery, presumably by neuropraxia…
The isolation of morphine from crude opium was one of the most important discoveries of nineteenth century medicine. In the early 1800s Friedrich Serturner (1783-1841), a pharmacist’s apprentice in Germany, was working on isolating the active principle of opium. Serturner’s first discovery in 1805, was a new acid, “mekonsaure” or “mohnsaure”, present in opium.1 However, trials on dogs revealed that mekonsaure was inactive. He then reported finding a water-insoluble crystalline substance which had an “almost alkaline-like character”; he called this the “principium somniferum”. Animal experiments proved this was indeed an active principle of opium. Serturner later named the active ingredient of opium “morphium” after the Greek god of dreams. In 1817 Serturner published another paper which, unlike his previous publications, received widespread attention. In a French translation of Serturner’s work, Gay-Lussac added an editorial in which he suggested the name morphine rather than morphium.
From the time of its discovery by Serturner, morphine was manufactured and used in an oral form, morphine acetate, which was a difficult and expensive salt to prepare. In 1831, William Gregory, an Edinburgh physician and chemist, discovered a cheap method of isolating and purifying morphine salts. However, there was no financial or clinical advantage in the use of morphine over paregoric and laudanum. These traditional media for delivering opium alkaloids orally were of similar cost and efficacy, and already established in the medical and public eye. It was not until the development of the hypodermic needle and syringe in the 1850s that the use of morphine became widespread.
Related: WaPo: Study Supports Opioid Painkillers For Older Patients.
That’s all folks for this week. Have a great weekend! Remember that the above laudanum recipe is not for celebratory purposes and not for home use. Thanks for stopping by, and see you next week.