Pyaemia is a form of septicaemia (blood poisoning) in which a bacterial infection spreads from an abscess and becomes systemic. The disease is characterised by abscesses all over the body, and in the days before antibiotics it was generally fatal. The only hope was to open the abscesses with the scalpel and drain them, removing the pus in which the bacteria multiplied. As late as 1892 the great physician Sir William Osler could offer little prospect of success to the physician faced with a pyaemia patient:
Treatment — The treatment of septicaemia and pyaemia is largely a surgical problem. The cases which come under the notice of the physician usually have visceral abscesses or ulcerative endocarditis, conditions which are irremediable. We have no remedy which controls the fever.
Almost twenty years earlier, however, The Lancet had published a case report by a Dr Frederick Daly in which he claimed to have cured a pyaemia patient. His magic remedy? Champagne – and lots of it:
On March 10th, 1873, I was consulted by a Swiss gentleman about a small carbuncle on the back of the neck. It was not larger than a shilling, and had already broken. I ordered a linseed poultice and cerate of resin.
A ‘cerate’ is a waxy preparation, slightly harder than an ointment.
He looked a little out of health, but not particularly so. He had, some years back, resided in India for five years, and suffered from dysentery there. Since then he has been very subject to boils. Has never had syphilis, and always been most abstemious. I recommended him to remain away from business for a few days, which he did, and to live generously, also prescribing citrate of iron and quinine. I saw him on the 11th, 12th, and 14th, when the little carbuncle had healed, and he expressed himself as feeling much better and ready for business. On the 18th of March I was again sent for to see him, and he informed me that “he was suffering from rheumatism”— that “his back and some of his joints were painful.” He certainly had intense pain in his back, and there were pains flying about the limbs and joints.
He was, as it turned out, suffering from something a great deal worse than rheumatism. He developed a high fever, and a couple of weeks later a large abscess appeared in his back, which when punctured produced over a pint (!) of pus. The doctor prescribed quinine (to reduce his temperature) and eight ounces of sherry daily – believed at this date to be a useful stimulant.
When Dr Daly visited his patient on March 31st, three weeks after the first onset of symptoms, his patient was very unwell.
He looked badly, and was very restless. To have as much champagne as he will take, and half a drachm of the sedative solution of opium at bedtime.
Many doctors believed that champagne was a particularly effective stimulant – it was even used as an injection in cases of surgical shock. Four days later there was little improvement, but the patient was drinking heavily.
He is low-spirited, and slightly deaf. He takes his nourishment badly, but has eight ounces of sherry and one pint of champagne during the twenty-four hours; he also takes twenty grains of quinine daily.
The man developed several further abscesses, which were duly lanced to remove the pus. On April 12th the doctor added this update:
Better. Temperature fallen to 101.2°; pulse 100. Tongue much cleaner; slept fairly well, and takes his nourishment again; he eats a large quantity of dry bread crust with his champagne; he now takes two pints of champagne and four ounces of rum during twenty-four hours; he takes also freely of soup, beef-tea, and gruel.
By now the patient was drinking over a bottle and a half of champagne per day, despite being seriously ill with a bacterial infection. The following day his condition deteriorated:
Called to him at midnight, I found him wandering and excitable. Has had only two ounces of brandy, and no other stimulant. He says he is unable to individualise the several parts of his body—i.e., cannot be sure that he has two hands or feet, and feels only “like a great lump of unshapen matter.” To continue the brandy and champagne.
This seems unwise. Nevertheless, the doctor increased the dose the following week:
His temperature varied from 101° in the morning to 104.4° in the evening. His tongue cleaned, and his appetite was good; his urine was normal, and he slept better at night. His spirits were bad, and he took three pints of champagne in twenty-four hours.
Two and a half bottles. Enough to get anybody drunk. But even this wasn’t enough:
He ate fairly well, having meat every day, such as chicken or pigeon, and also having vegetables every day; but he gained no strength, and his prostration was extreme. He took five pints of champagne in twenty-four hours.
He was now consuming close to four bottles of champagne per day – around 35 units of alcohol, far more than the recommended weekly maximum. This was not the only medication employed, however: on May 13th, with his patient very much worse, Dr Daly and a colleague decided to try a different tack.
In consultation Mr. Hutchinson proposed to give our patient small doses of mercury. He advised the trial of mercury because our present treatment had not the least control over the formation of pus. We had hitherto found that whenever the discharge ceased from the abscesses a fresh one formed, or one which had ceased discharging began afresh. We therefore gave him two grains of mercury-with-chalk three times a day, and to continue his steel, quinine, and stimulants.
For this entire period the patient was drinking three pints of champagne a day – though the dose was finally reduced at the end of May:
May 27th to June 3rd.—There is not much to note this week. His pulse and temperature continued the same; he slept remarkably well, and, as his appetite was now very good, I stopped the rum, and reduced his champagne to two pints, and this, together with a tumbler of Swiss wine, Veltliner, which he has with his dinner and much enjoys, is all the stimulant he has.
Just the two bottles; fancy! In the last week of June his condition became grave.
His prostration was extreme. He became quite deaf, and ultimately became so exhausted that he could scarcely bear the application of the lotion. The nervous prostration and muscular exhaustion were very great, his hands and tongue were tremulous, and the hyperasthesia was exquisite. Mr. Hutchinson saw him with me during this period, and we despaired of his life, but the free use of stimulants kept him alive. During each twenty-four hours he took twenty-four ounces of port wine, a pint of champagne, and eight ounces of brandy, together with milk, beef-tea, and beaten up-eggs.
An almost incredible diet for a man whose life hung in the balance. But still the doctor increased his alcohol intake:
On the 21st, his morning temperature was down to 101°; pulse 132. Mr. Hutchinson, when he saw him with me in the afternoon, expressed the most unfavourable opinion of the case. We found him deaf, sleepy, and dull, dozing to sleep while you were speaking to him… We increased his port wine to three pints during twenty-four hours, in addition to the brandy and champagne.
A frankly extraordinary amount of alcohol. Port is around 20% alcohol by volume; he was drinking more than two bottles of the stuff in addition to large amounts of champagne and brandy. His liver must have been pickled.
The extra amount of stimulant agreed with him.
This must remain a moot point. In July Dr Daly went on holiday for a few weeks; when he returned in August he was pleased to find his patient rather better:
On the 13th he was carried into the garden and lay on a sofa there for a few hours, and the following day was lifted into an open carriage and had a drive. He continued to take a drive daily, when the weather permitted, until he went to the seaside.
This time his improvement was genuine. Though he still suffered outbreaks of a nasty bacterial skin rash, the abscesses were in retreat and by the autumn he was finally on the mend.
I visited him at Hastings on the 7th of October, and he could then walk well from room to room with crutches. On his return to London his walking powers still further improved, and by the 11th March, 1874, he was sufficiently well to go to Liverpool, to resume the office work of his business there, and could walk three or four miles.
A happy outcome, but I can’t help wondering how much more quickly he might have recovered if he had not been made to consume dangerous amounts of alcohol. If he didn’t become an alcoholic as a result of this therapeutic regime, I bet he couldn’t stand the sight of champagne for the rest of his life.