BROMPTON'S COCKTAIL

In 1896 the English surgeon Herbert Snow showed that morphine and cocaine, when combined into an elixir, could give relief to patients with advanced cancer. About thirty years later a similar approach was used at London's Brompton Hospital as a cough sedative for patients with tuberculosis. In the early 1950s this formulation appeared in print for the first time, containing morphine hydrochloride, cocaine hydrochloride, alcohol, syrup, and chloroform water.

In her first publication, Cicely Saunders, the founder of the modern hospice movement, also referred to such a mixture, which included nepenthe, or liquor morphini hydrochloride, cocaine hydrochloride, tincture of cannabis, gin, syrup, and chloroform water; she was enthusiastic about its value to terminally ill patients. Over the next twenty years of writing and lecturing, Saunders did much to promote this mixture and other variants of the "Brompton Cocktail."

A survey of teaching and general hospitals in the United Kingdom showed the mixture and its variants to be in widespread use in 1972. Elisabeth Kübler-Ross, the psychiatrist and pioneer of endof-life care, became one of its supporters, as did some of the pioneers of pain medicine and palliative care in Canada, including Ronald Melzack and Balfour Mount, who saw it as a powerful means of pain relief.

The Brompton Cocktail became popular in the United States, too, and at least one hospice produced a primer for its use which was distributed to both clinicians and patients. Indeed, as a leading pain researcher and hospice physician, Robert Twycross noted, there developed a "tendency to endow the Brompton Cocktail with almost mystical properties and to regard it as the panacea for terminal cancer pain" (1979, pp. 291–292).

The cocktail emerged as a key element in the newly developing hospice and palliative care approach. Then, quite suddenly, its credibility came into question. Two sets of research studies, published in the same year, raised doubts about its efficacy—those of Melzack and colleagues in Canada and Twycross and associates in the United Kingdom. Both groups addressed the relative efficacy of the constituent elements of the mixture. The Melzack study showed that pain relief equal to that of the cocktail was obtainable without the addition of cocaine or chloroform water and with lower levels of alcohol, and that there were no differences in side effects such as confusion, nausea, or drowsiness. Twycross's study found that morphine and diamorphine are equally effective when given in a solution by mouth and that the withdrawal of cocaine had no effect on the patient's alertness. Twycross concluded, "the Brompton Cocktail is no more than a traditional British way of administering oral morphine to cancer patients in pain" (1979, p. 298). Despite these critiques of the cocktail, its use persisted for some time; however, in the twenty-first century it does not have a role in modern hospice and palliative care.

Bibliography

Davis, A. Jann. "Brompton's Cocktail: Making Goodbyes Possible." American Journal of Nursing (1978):610–612.

Melzack, Ronald, Belfour N. Mount, and J. M. Gordon. "The Brompton Mixture versus Morphine Solution Given Orally: Effects on Pain." Canadian Medical Association Journal 120 (1979):435–438.

Saunders, Cicely. "Dying of Cancer." St. Thomas's Hospital Gazette 56, no. 2 (1958):37–47.

Twycross, Robert. "The Brompton Cocktail." In John J. Bonica and Vittorio Ventafridda eds., Advances in Pain Research and Therapy, Vol. 2. New York: Raven Press, 1979.