In the early 20th century, a mysterious mixture of morphine and cocaine (upper left, first and third bottles) assuaged the pain of tuberculosis patients at Royal Brompton Hospital in England (lower image). This “Brompton cocktail” also contained gin (or brandy) and syrup, with chloroform water (upper left, second bottle) added as a sweetener and disinfectant. The concoction’s charming name only enhanced its mystique. In the 1960s, Dame Cicely Saunders (1918 to 2005, upper right), physician and hospice pioneer, popularized the potion as a mainstay of palliative care. Later, she would also oversee its deconstruction. Working for Saunders, physician Robert Twycross would examine the cocktail’s individual components through several randomized controlled trials. One study showed the inclusion of cocaine to be associated with a minimal increase in alertness and no difference in analgesia (BMJ 1977; 2:1348). Two years later, a Canadian trial showed similar efficacy between a standard Brompton cocktail and morphine alone in flavored water (CMAJ 1979; 120:435–8). Soon, the enchanted elixir would lose its luster, and pain treatment would shift from the magical to the measurable, the mystical to the precise. (Clark D. In: Opioids and Pain Relief: A Historical Perspective. IASP Press, 2003. Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology. www.woodlibrarymuseum.org)
In the early 20th century, a mysterious mixture of morphine and cocaine (upper left, first and third bottles) assuaged the pain of tuberculosis patients at Royal Brompton Hospital in England (lower image). This “Brompton cocktail” also contained gin (or brandy) and syrup, with chloroform water (upper left, second bottle) added as a sweetener and disinfectant. The concoction’s charming name only enhanced its mystique. In the 1960s, Dame Cicely Saunders (1918 to 2005, upper right), physician and hospice pioneer, popularized the potion as a mainstay of palliative care. Later, she would also oversee its deconstruction. Working for Saunders, physician Robert Twycross would examine the cocktail’s individual components through several randomized controlled trials. One study showed the inclusion of cocaine to be associated with a minimal increase in alertness and no difference in analgesia (BMJ 1977; 2:1348). Two years later, a Canadian trial showed similar efficacy between a standard Brompton cocktail and morphine alone in flavored water (CMAJ 1979; 120:435–8). Soon, the enchanted elixir would lose its luster, and pain treatment would shift from the magical to the measurable, the mystical to the precise. (Clark D. In: Opioids and Pain Relief: A Historical Perspective. IASP Press, 2003. Copyright © the American Society of Anesthesiologists’ Wood Library-Museum of Anesthesiology. www.woodlibrarymuseum.org)
Jane S. Moon, M.D., Assistant Clinical Professor, Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California.
