It’s been a little while since I’ve had the time to write a blog post. The reason for this hiatus is that my wife and I have been preparing for our move to Canada, where we’ll be living for the next twelve months. We arrived in Toronto earlier this week, and wasted no time in discovering the superb local craft brewery. In honour of our new home – and in misguided tribute to the wonders of alcohol – here’s a case that combines the two. This first appeared in the Canada Medical and Surgical Journal in 1874.
In an overview of recent cases admitted to hospital in Montreal, an anonymous author observes that the wards then contained ten cases of typhoid. Most were unremarkable, but one in particular displayed ‘peculiarities worthy of mention’:
The patient is an English emigrant who, at the time she was attacked, was still suffering from the effects of the sea-voyage, and, consequently, little fitted to withstand an attack of typhoid fever. On the evening of the day of admission, which was the fifth of the fever, the temperature was 105, and the pulse 124.
Her temperature was slightly over 40.5C and therefore certainly worrying.
There was diarrhoea; tongue already dry; great gastric disturbance as evidenced by constant nausea and occasional vomiting; delirium at night from the first; sleep at all times restless, and of that moaning kind so often seen in febrile conditions. She was ordered the ordinary fever mixture of the hospital, whose chief ingredients are hydrochloric acid and chlorate of potash…
A rather scary mixture of chemicals. Chlorate of potash (potassium chlorate) is not only toxic, but also a powerful oxidising agent whose effects can be so explosive that it is often used in fireworks. It was sometimes used (as a weak solution) to treat fevers in the nineteenth century – although its combination with hydrochloric acid is somewhat mystifying, since the two compounds react to produce chlorine gas. The patient was also allowed a diet of milk (‘in abundance’) and a pint of beef tea every twenty-four hours.
On the second day after admission the more serious symptoms being unabated, and the pulse, and tongue of that character indicating stimulants, four ounces of port wine were ordered to be given during the twenty-four hours.
Alcoholic drinks were at this date believed to be useful stimulants – as late as 1915 brandy or whiskey were still being given to patients immediately after surgery.
A week after the patient’s admission, her condition was little better. She still had a raging temperature, her pulse was unnaturally fast and she was constantly delirious.
Dr. McCallum now despaired of saving his patient, but as a dernier resort ordered stimulants almost without limit.
By which he meant as much alcohol as possible.
Eight ounces of brandy were substituted for the wine, and even this was to be added to if necessary, before his visit on the following day. In twenty hours a pint of brandy had been consumed, either made up with water hot and cold, or given at times in milk or beef tea as the ingenuity of the nurse might suggest, and the effect even now was marvellous.
Around half a litre of brandy – quite a lot for anybody at any time, but for a nineteenth-century woman laid low by typhoid, almost unthinkable.
The chart shows on the evening of the 13th day of the fever, a temperature of 103¼, and on the morning following it had fallen to 100¾, pulse 116; mental condition much clearer; diarrhoea entirely abated; condition most promising.
Certainly a striking improvement. But was it anything to do with the brandy? The doctors certainly seemed to think so.
It is unnecessary to follow the case further than simply to state that this process of stimulation was continued uninterruptedly for five days, after which the brandy was gradually diminished in quantity; that the symptoms once so alarming were regularly beaten back by the stronger ethylic foe; and that the patient, with the exception of a trifling relapse, is making a good recovery.
It should I hope go without saying that strong spirits ‘almost without limits’ are not recommended as a treatment for any infectious disease.