Tetanus is a bacterial infection usually contracted through a skin wound – in the days before a vaccine was widely available, cases were fairly common and could follow something as trivial as pricking a finger on a thorn. Before the twentieth century physicians had few therapeutic options. But in 1798 a doctor from New York found a novel way to treat tetanus patients; get them really, really drunk.
In The Annals of Medicine for 1799, Dr David Hosack sets out his stall:
Having, in a variety of diseases, attended with great exhaustion of the vital powers, employed wine alone with success, without the use of those remedies which are usually prescribed in this condition of the body, I long since resolved to give it a trial in locked jaw. On Tuesday, March 13, 1798, about one o’clock, p.m. I was called to visit a mulatto servant-woman, of John Harrington, Esq. of this city.
In case histories of this period, patients are usually named: interesting that this ‘servant-woman’ is only identified by the name of her master.
I was informed, that, about an hour before, while employed in washing clothes, she had pricked herself with a pin in the wrist of her right arm. The pin was instantly removed; and, finding no inconvenience from the accident, she returned to her employment. In a short time, she felt a great degree of soreness in the part which had been injured; with pain, shooting occasionally to the arm, shoulder and neck.
These early symptoms were soon followed by stiffness around the throat, difficulty swallowing and finally a locked jaw, the classic symptom of tetanus. Dr Hosack was called for.
Although I have been long since convinced of the insufficiency of opium in this disease, in the hurry of the moment, I gave her about sixty drops of laudanum, in a small quantity of wine. Her jaws being closely locked, it was with great difficulty administered.
This did not go down well: she vomited violently, complaining of great pain in her stomach.
The anodyne draught was entirely rejected; but, upon a moment’s reflection, I did not regret this circumstance, as the disease assumed a very decided character, and I had made up my mind to rely upon the effects of wine alone. Accordingly, about two o’clock, I directed a large wine-glass full of Madeira wine (the glass containing about two ounces), to be given punctually every hour; and a cup of sago, and panada [a sort of bread soup], with wine, to be given from time to time, as her nourishment.
At this point a second doctor arrived, and after discussion dressed the wound with ‘lunar caustic’ [silver nitrate, which has antiseptic properties] and a poultice of bread and milk.
The wine was administered with great fidelity, by the mother of the patient, until about five o’clock the next morning. She had some slight convulsions in the course of the afternoon, but they were more of an hysterical sort, induced by her great anxiety of mind, than to be ascribed to the disease itself. Generally speaking, there had been a very manifest abatement in all her symptoms; and she passed a more comfortable night than could have been expected. At five o’clock the next morning, her mistress, alarmed at the quantity of wine she had taken, desisted from its further use.
I don’t blame her.
From this time, appearances became more unfavourable; and, at eight o’clock, her jaws, which had been relaxed during the plentiful use of wine, again became stiff, and closed. We saw her at nine, and immediately gave her about half a pint of wine; and ordered it to be administered as before.
At one, her symptoms were greatly changed. We found her sitting up in bed, eating small portions of roasted oysters, which she had called for. At this time, her jaws were almost in the natural state. She had taken her wine punctually as directed; and had experienced no inconvenience from it whatever although in health she had not been accustomed to its use… Finding this mode of treatment to agree so well with her, we directed it to be continued.
The following day she was so much better that Dr Hosack decided to decrease the dose. But this was a mistake:
She remained in a very comfortable condition until the afternoon. But the pain in her hand then returned with violence; extending to her arm and neck as before. Her jaws were again closed. The rigidity of the muscles at the back of her neck returned. Her mind became greatly agitated… She fainted, and had several slight convulsions.
Being called at that time, I gave her, with some difficulty, about half a pint of wine; and directed a warm poultice to be immediately boiled. When prepared, I poured upon the surface of it about half an ounce of laudanum, and applied it to the wound. Her symptoms were in a short time allayed. I left her, directing the wine to be continued as before, a large wine-glass full, every hour.
Her saw her again in the evening. Although her jaws were less firmly closed, she still had some pain in her hand. She continued to drink a large glass of wine every hour, and when Dr Hosack visited her the following morning her jaws had completely relaxed, and she had little pain. But, fearful of a relapse, he ordered that she should maintain her intake of wine.
In the evening we observed the wine had exhilarated her spirits. She became very talkative.
Given that she had been drinking wine day and night for the best part of 48 hours, it’s a miracle that she was still conscious.
We directed the wine to be administered through the night, but in smaller quantities, and at longer intervals, unless her complaints should return, and demand a continuance of it as before. Saturday morning, we were informed she had slept the greater part of the night; and had taken but a small quantity of wine. Her symptoms being in all respects favourable, the wine was discontinued, except a small quantity mixed with her nourishment… From that time, she remained free from any return of her complaints, and has since been in perfect health.
Upon calculating the quantity of wine she had taken, it amounted to three gallons.
That’s twenty-four pints; eighteen bottles; and if we assume this madeira was on the weak side, 216 units of alcohol. In a little over three days. I wonder if it was all worth the monumental hangover that must have followed. Thankfully there’s little evidence that Dr Hosack’s regimen was more widely adopted.