Many substances, usually in combination, were used to alleviate pain. Most of these pain relievers were from plants; they were often powerful and when taken in overdose, deadly. One of the most commonly used substances was opium derived from the poppy flower, Papaver somniferum. Amongst other substances used were alcohol or wine, mandragora or mandrake from the plant Atropa mandragora, belladonna from the deadly nightshade, and marijuana or Cannabis indica. Extracts from such plants as hellebore, henbane, datura, and hemlock were used carefully, their strength being recognized.

Opium

	Poppy (Papaver somniferum) (From: Flora medica London: Callow and Wilson, 1829.

Opium was used throughout the 19th century, often as laudanum or tincture of opium, which is a combination of opium and alcohol:

"Laudanum: The common name for Tincture of Opium, and the form in which that drug is most frequently administered. . . It is narcotic, sedative, and being made with spirit, is also, to a certain extent, stimulant and anti-spasmodic. For relieving pain, wherever situated, to diminish irritation, and to procure sleep, it is the best of the medicines we possess." (From: The Family Doctor, a Dictionary of Domestic Medicine and Surgery, by a Dispensary Surgeon. London, c.1860)

The Soporific Sponge:
A Medieval Anesthetic Device

Although major surgeries such as amputations were performed without anesthesia and patients seemed to bear extraordinary pain with stoicism, there was a search for pain killers.

For centuries, the medical literature of the Middle Ages described and endorsed this curious anesthetic device the soporific sponge. Texts on the soporific sponge survive from every century from the 9th through the 13th, and it was still described from the 14th through the 17th centuries, though with increasing warnings about contraindications. Eventually they mention the sponge only as a fact of history, a memory from a time when "surgeons were more merciful." The following is a recipe for the soporific sponge from Theodoric of Cervia from the work, Cyrurgia (Venice, 1498):

"The composition of a savour for conducting surgery, according to Master Hugo, is as follows: take opium, and the juice of unripe mulberry (probably a textural mistake for black nightshade), hyoscyamus (henbane), the juice of hemlock, the juice of leaves of mandragora, juice of climbing ivy, of lettuce seed, and of the seed of the lapathum (dock) which has hard, round berries, and of the water hemlock, one ounce of each. Mix all these together in a brazen vessel, and then put into it a new sponge. Boil all together out under the sun during the dog days, until all is consumed and cooked down into the sponge. As often as there is need, you may put this sponge into hot water for an hour, and apply it to the nostrils until the subject for the operation falls asleep (he who must go under the knife,--llit. be cut into). Then the surgery may be performed and when it is completed, in order to wake him up, soak another sponge in vinegar and pass it frequently under his nostrils. For the same purpose, place the juice of fennel root in his nostrils; soon he will awaken."

Self-Dosing

People treated themselves and their families for pain, buying over-the-counter patent medicine remedies. Most of these were alcohol or opium-based compounds. For severe or post-operative pain, the physician might inject morphine, which had been isolated from opium in 1806. Towards the end of the century, German chemical companies introduced new compounds: acetanild and the salicylates, which effectively relieved moderate pain, although not without side effects. The salicylates, for example, might induce gastric pain, even ulcers. In 1899, the Bayer Company introduced a stable, easily tolerated salicylate, acetylsalicylic acid, which under the trade name aspirin quickly became the best selling medication in the world.

Morphine

In 1803 Friedrich Wilhelm Sertürner (1783-1841) isolated crystals of a powerful analgesic agent from crude opium. Sertürner named the chemical morphine, after Morpheus, the Greek God of dreams. It could be introduced on the point of a lancet or a solution could be washed into a wound.

Syringe

In the 1850's Charles Gabriel Pravaz (1791-1853), a French surgeon, and Alexander Wood (1817-1884) of Edinburgh independently invented the syringe. Injections of morphine were generally used for local pain.

Felix Hoffmann and Aspirin

	Portrait of Felix Hoffman		Five vintage Bayer® bottles and tins, 1930-1955 [Used with permission of Bayer Corporation]

The real wonder drug proved to be a compound found naturally in willow tree bark or meadow grasses. In 1897 Bayer chemist Felix Hoffmann developed a stable form of this natural compound which could be safely used by most people, without side effects. Acetylsalicylic acid (ASA), sold by Bayer under the trade name "Aspirin," was the first reliable and effective such pain killer or analgesic.